On What Would Have Been the Launch of Cannes, a Celebration of 26 Film Festivals — and 26 Festival Directors | Filmmaker Magazine

&The Cannes Film Festival and Market

by Kaleem Aftab
in Festivals & Events
on May 12, 2020

Film festivals are all about a community coming together to celebrate an art form that we all love. They were one of the first group of events to cancelled when the coronavirus began to spread. The current crisis in the film industry (and across society and the economy as a whole) — the job losses and closures — made it difficult to publish my look back over my year in film festivals, as I’ve done on an annual basis for Filmmaker since 2014. (Also, I had broken my finger over Christmas so was unable to type for three weeks, which is when I usually pen these articles!) Plus, because last year I’d been to 26 film festivals, a record for me, the piece also took a long time to write.

Twenty-six film festivals is a lot. In December of last year, I promised my partner that in 2020, I would go to fewer festivals. Little did we know that my hand was going to be forced by the tragedy of a virus pandemic. Looking back, I’m so glad I went to so many in 2019, seizing the day like I was in the Dead Poets Society.

Sitting here right now, as Cannes would have begun, I believe we will be lucky to see a film festival happen in a traditional way again in the Fall — if then. For all the efforts to put festivals online, there is nothing that matches the intoxicating atmosphere and excitement of attending. That’s why I go to so many of them. I miss hearing a projector whir and seeing a film for the first time, listening to filmmakers talk about their projects, the conversations with fellow attendees, the pitching of projects, those celebrating great reviews, others commiserating. I even miss the 10-minute standing ovations made more out of courtesy rather than enthusiasm. I’ve even started doing this at home now.

So while it may seem odd to have a look back at 2019 film festival season in May, it also seems so fitting to publish today. Absence has made the heart grow fonder. Right now is a time when the role of film festivals is being analysed more than ever by festival directors, as they decide what is essential, what they have to keep, or for some, what they can replicate online. Most importantly, film festivals have to comprehend how can they stay relevant when the spectacle that is their heart is on life-support.

In my mind, there is nothing quite as exhilarating as attending a film festival. I look forward to the moment of being able to participate in more than 26 festivals in a year. (Just don’t tell my partner!).

The festival director is the public face of a film festival. They guide the program and set the agenda. But who are they? In 2019, I tried to meet as many festival directors as possible, and from time-to-time chat about the poster of the festival. I wanted to know if I could see the personality of the festival director at the event. Little did I know when I started this process in January that I would go to 26 film festivals, either as a journalist, moderating Q and A’s or giving talks on festival strategy. 

Tromsø International Film Festival 

Festival Director: Martha Otte

American Martha Otte first worked as a volunteer at the Tromsø International Film Festival in 1998. By 2005 she became festival director. 2019 was her last year as the position at Tromsø  I’ve known Martha for several years, first meeting her at the now-defunct Abu Dhabi Film Festival. We’ve bonded over films. I’ve appeared on the jury at Tromsø in the past, and this year, she asked me to do the Q&A sessions with Canadian filmmaker Philippe Lesage, following screenings of his excellent coming-of-age drama Genesis.

It takes a kooky personality to want to live in the Arctic Circle, where during the film festival, the sun never quite rises above the horizon. Despite all the darkness, the irony is that Otte is an insomniac. Luckily she’s found a profession where staying up in the dark is a necessary component.

Otte says of her philosophy to running the festival: “We are especially interested in films that are ‘off the radar’ and are not standard festival fare, which doesn’t mean experimental; it just means we want to make our own discoveries.”

I was too busy buying trinkets with Gaspar Noé and chasing the Aurora Borealis to make too many movie discoveries of my own. It’s that kind of place! The one discovery I made was Egil Håskjold Larsen’s Where Man Returned, about a lonely old white man lives in the Arctic wilderness with his dog. He listens to football and shipping news on his radio. It was a metaphor for so many conversations had at festivals this year. 

One thing that did catch my eye was the poster of the festival. It featured an image of a figure dressed in a thawb with the face drawn as the Tromso Film Festival logo. The poster was designed by Christopher Ide (AKA Doffa), of design office Tank, and he has been the go to guy for the festival for a number of years. The image was smart on so many levels. Since 2001, Tromso and Gaza have been twin cities. The festival also had a strong focus on Arab cinema with screenings of Sameh Zoabi’s satire of the Palestinian-Israeli conflict Tel Aviv on Fire, Dalia Kury’s prison recreation documentary Privacy of Wounds, and a section called Arabiyat — the Arab word for women — celebrating female filmmakers from the region and programmed in association with Morocco’s Cinematheque de Tanger.

Rotterdam International Film Festival 

Festival Director Bero Beyer

The next festival I attended was another festival where the festival director was looking to move their life away from festivals. In July, Rotterdam head honcho Bero Beyer announced that he had accepted a job as CEO of the Netherlands Film Fund, commencing in March 2020, after this years’ edition. More recently, it was announced that his replacement would be MUBI acquirer Vanja Kaludje, who had previously worked for the festival. 

2019’s edition was Beyer’s fifth in the post. He’s a confident guy. In the role, Beyer has grown the industry side of the festival and increased the focus on experiences rather than just watching films. The festival takes place when a lot of American eyes are on Sundance, but he’s keen on appealing to the 180 ethnicities found in Rotterdam. “The first thing we want to get right is that the program is representing the world and not just one side of the world,” Beyer tells me on his way to a Claire Denis seminar.

Beyer says of his philosophy to the festival, “We do what others don’t. We always go one step further. What makes us special is the stuff that is slightly crazy and on the fringe of things. People show up to watch avant-garde.”

The film festival posters are part of a campaign living under the umbrella of “Planet IFFR.” Planet IFFR is a concept formulated in 2017, where the emphasis was put on the number of people involved in the movie making process. The various staff on a set are in Rotterdam’s eyes, representive of the cultures and peoples of the world. “This year, we asked what makes us alive? It’s more than facts and truth because they are long gone, facts don’t matter – it’s emotions.” 

“In the poster campaign the faces and the words used to describe the expressions being pulled seem to conflict. There is a happy face, but the poster says angry. These seemingly oppositional emotions are reflected in the films we show. Our cinema doesn’t give you an answer – it gives you a question. The films don’t give you a feeling you have foreseen – they give you an emotion you have not anticipated it’s like a rollercoaster ride without a seatbelt.”

A case in point is Sacha Polak’s Dirty God, an international co-production that blurs fact and fiction by having Vicky Knight, who was a victim of an acid attack, play the victim of an acid attack. Yet from this starting point, a cinematic truth emerges, very different from reality. Or Present.Perfect, the Hivos Tiger Award winner, which is made up of footage of China taken from the Internet by Chicago based Chinese director Shengze Zhu.  

Beyer admits that the pluralism highlighted in the program could be better reflected in the diversity of the staff, stating, “That’s an on-going process.” And one from next year, he’ll presumably be pushing his successor to achieve.

Gothenburg Film Festival 

Festival Director: Jonas Holmberg

Gothenburg is Scandinavia’s biggest film festival, and just like Scandi Noir, it remains something of a mystery to me. It’s the one festival where I make an extra effort to watch the pitching session, where some filmmakers talk about the movies that they intend to make, and also others talk about the films that are deep into post-production. It’s intriguing as there is always something that ends up at Cannes, and not always what you expect. Usually, I hate seeing movie trailers or knowing anything about a film. Nonetheless, somehow I can listen to a Scandinavian auteur talking about their project in intricate detail, and yet see something entirely different on-screen. Is this because of what they say, or how I listen?

I did not know artistic director Jonas Holmberg before the festival. That despite the fact he’s been the head honcho at Gothenburg since 2014, when he was promoted from his position as international film programmer, and I’ve been to previous editions under his watch. His route into festival life was as a film critic. It’s interesting as that once familiar way into programming has gone into decline as dedicated film programmers appear, graduating from film schools, which have recently started hosting courses in curating and curating theory.

Holmberg seemed to be the quintessential Scandinavian when I met him. He dresses well and says all the right things. My younger self would have looked at him like the epitome of cool, but now I find him a little awkward.  He’s also good-natured. When I start by asking him about his poster, his reaction is a sincere, “How wonderful!” There’s a lot to like.

“We have a tradition of asking a local artist to design the poster,” states Holmberg. “They’re given a blank slate to design whatever they come up, and they come back to us with their design. It’s one of the most exciting days of the festival seeing what they have designed.”

It’s a very relaxed way of doing things and it has been that way since 1992. It also means that a look at the festival poster archive is like a journey to a gallery. The theme of the 2019 film festival was Apocalypse, which might explain how I came to watch a movie, Aniara, from the inside of a coffin. Jesper Waldersten was the artist chosen to create the one-sheet and created an eerie yet beautiful work in the style of horror and space movies from his childhood. Think, Alien, David Lynch and John Carpenter, then throw in a bit of Bergman, think of that image in black and white, and with a face populated by figures looking like they stepped out of Jake and Dinos Chapman’s Hell. 

The Scandi vibe was also apparent in Swede Anna Eborn’s fantastic Transnistra, a film that felt like the ’70s even though it is a breakaway state on the border of Moldavia in present day.

Berlin Film Festival 

Head of the Berlinale: Dieter Kosslick

It was Dieter Kosslick’s last stand at the Berlin Film Festival. The year before many prominent German film industry figures called for a change at the top of the Berlin Film Festival arguing that the festival had become irrelevant. The call was heeded and before the festival it was long since announced that his 18th edition would be his last. Kosslick is a unique character. His style and matter is defiantly old school, and eccentric. In his final year, Kosslick programmed a festival that was staunchly unapologetic. No bones thrown to those who criticised him. So the festival was full of challenging choices and featuring buried treasures for those who looked deep into the program. It will be interesting to see how and if that takes changes under the new guard. 

Kosslick attended an event that I organized to celebrate the life and work of publicist Richard Lormond, who had died from an illness a few months before the festival. Kosslick took time out of his busy schedule to say some kind words, and it served as a reminder that the work of a festival director at a festival is more than about selecting films and is also about social interactions. Acknowledging the work of those who help contribute to an event’s success is important as it takes many to put together a great festival.  

Later in the festival, as we sat down to talk about his legacy and the Berlinale poster, I couldn’t help but think that retirement had come at the right time for Kosslick as he was being outpaced by changing times. 

“The bear is our symbol. And for a couple of years now, Swiss artists have been doing our poster,” said Kosslick. “For a couple of years now, the bear has been cruising around going to different locations in Berlin. A lot of people have been asking who are these bears? We thought because it’s the end of my tenure, we would lift the secret of the bear. When the bear takes off his head, it’s the audience that is underneath. The bear is normal people who are on the way to the Berlinale.”

Over the past 18 years, he has worked with many agencies, and they all come up with very different designs, which is evident in the change in the style of the posters every few years. 

“This year, a discussion arose because there was a black person in one of our costumes and we talked about what would be the symbolism of having a black person in a bear costume,” admits Kosslick. “Would it look like discrimination? We wanted to show the variety of the audience that attend the Berlinale, but we have been afraid that if we used it, it would create a discrimination debate. Two people on our poster were from our staff were used as well. I don’t know all of the people personally. We thought about putting me in a costume, but in the end, we believed it was too much.”

The Berlinale like many other festivals this year signed the 50/50 by 2020 pledge to pursued gender parity. “The pledge was a political aim, but I think we are far ahead at the Berlinale,” says Kosslick. We have seven films from female directors in competition and with our staff and selection committee, there are a lot of women in prominent positions.’

Indeed, the film that stuck out most at the festival to my mind was a film screened out of competition, because it had been at Sundance, Joanna Hogg’s The Souvenir.

Stockfish Film Festival 

Festival Director: Marzibil Snæfríõar Sæmundardóttir

Taking place in Reykjavik, Stockfish Film Festival is an event that wants to showcase Icelandic films to industry people to film exhibitors, programmers and distributors from around the world. Several Icelandic bodies come together to promote their wares, and it’s a great excuse to go to one of the most beautiful places in the world, with a burgeoning and exciting coffee scene. Yup, already by early March, coffee was my fuel.

The main two strands at the festival are an industry-pitching event, which has an overlap with Gothenburg and a competition programme of short films. There are also screenings of best of the fests, aimed to get the local audiences out of their warm wooden houses and into the fabulous cinema Bíó Paradís. From floor to high ceiling on one wall of the cinema are some fantastic posters designed by local artists to coincide with the release of huge movies, so it’s no surprise that Stockfish take their poster design seriously as well.

Sæmundardóttir has been the Festival Director of the Stockfish film festival since 2015. Before that, she was a writer and director. It was her love of film, and life, that led to her taking on the festival director role. A social butterfly, she brings a lightness and fun air to the event and promoting movies.

“We use a young designer and last year he came up with a version of yellow, which we liked a lot, and that has become the color of the festival,” says Sæmundardóttir. “The poster is exactly the same as last year, except for the dates!”

This attitude seems about right for a festival that knows what it wants to be and has a focussed goal. It’s a festival that has a great atmosphere, mainly because all the films take place in one cinema. They pick at most 25 films, which they consider the best of the fests, in addition to the industry events. The one thing they want everyone to watch is the local short films, which is a good way to start taking notice of local talent, and for local talent to realise that they’ll end up needing to make European co-productions if they want filmmaking to be their job. 

Bergamo Film Meeting 

Artistic Director: Angelo Signorelli

I love going to festivals that are off the beaten track. The Bergamo film meeting is one of those delightful festivals where much of the joy is in seeing classic movies on the big screen. There are new films that play, but I was more interested in seeing Jean-Pierre Léaud turn up to a screening of The 400 Blows, as part of a retrospective on his films, an exhibition of photographs from the set of Pier Paolo Pasolini’s Arabian Nights and a retrospective on filmmaker and cinematographer Karpo Godina, an exponent of Yugoslavia’s “Black Wave.” In 2020 they were set to take an in-depth look at Jerzy Skolimowski. It’s a festival that loves outsiders. 

The desire to take a new look at the past is imprinted on the festival’s poster, which gives us a classic French New Wave shot of a young Léaud on the set of The 400 Blows in triplicate. Festival director Angelo Signorelli, who helped found the festival, struck me as a laid back, conscientious type. The easy-living style is one that he is happy to replicate at the festival with a communal ethos. A committee seemingly decides everything. No wonder it’s called the Film Meetings, because, in my two days in Bergamo, it felt like a shared experience, one where good coffee shops were not too far away and talking about films was as important as watching them. 

Signorelli had a similar attitude to the marketing material, “The poster is a collective choice. We liked the image a lot this year. It’s cinematographic, suggesting movement and different perspectives. The central focus is on the repeated image, which is also out of focus. In a way, it speaks about the complexity of cinema. How by looking at the cinema of the past, and the present, we see future trends. It reflects the multiplicity of the sections that the festival has.”

For the past four years, SUQ Republic has designed the poster. “They really understand the philosophy of the film meetings.”

Qumra  

Festival Director: Fatma Al Remaihi

The Doha Film Institute has been doing great work over the years, and industry gathering Qumra continues to be a success. It’s often a sign of confidence of an organisation when they are not afraid to admit to divided opinions and frank discourse. The following conversation between Festival director, Fatma Al Remaihi and DFI’s Director of Strategy and Development Hanaa Issa about the poster for this year’s event was one of my favourite moments of the year. 

Fatma: These images [on the numerous posters] represent the projects that we have, the jewels of Qumra. The principal image for the main poster and front of catalogue is from the first Qatari film in post-production and for us that is huge.

Hanaa: The circle in the poster is kind of our symbol. It reminds of the Q for Qumra and also the camera lens.

Fatma: But the question we had was, do we want to use an image that represented peace, or did we have one that was about war?

Hanaa: We had a long debate.

Fatma: We had different opinions. Do you want to tell him yours?

Hanaa: We had a debate. There was this one behind you, and in terms of artwork, it worked well with the colour and catalogue. I surveyed the office, and some of us felt that highlighting on the book of the projects and on the main catalogue an image of soldiers and war, especially of soldiers killing the farmers in Mexico, that this was perhaps the wrong message to send out to the world. We opted to go for something more peaceful. But then we had this debate around the fact that we do live in a hostile world, there is a lot of unfairness and injustice. Even though we want to highlight this, and make it part of the conversation, I thought to put an image that represented hope was more suited to who we are at Qumra, especially as our projects already contain a lot of stories about war and refugees.

Fatma: Whereas I thought that the world is a mess, and we should highlight it and not be afraid of it, we are not celebrating it, we are highlighting it. We spent the whole day with this discussion.

Hanaa: We argue all the time. We’ve known each other for a long time.

Fatma: It took the whole day this discussion. Going into work that day, I knew that we were going to have this discussion.

Hanaa: Me too, I ate a good breakfast, so I was ready to stand up for my view.

London Taiwan Film Festival UK

Festival Director: Aephie Huimi

I went to the opening day of the inaugural festival. They have a tie in with Stockfish, patly because Festival Director Aephie Huimi has strong links to Iceland and Taiwan. The opening was the UK premiere of Tsai-Ming Liang’s VR cinematic experience, The Deserted, with the director in attendance. I’d inadvertently had a hand in this happening, as I met Huimi through a producing pal friend of mine a number of times. When she revealed she was thinking of putting on a Taiwan Festival in the UK, I immediately mentioned The Deserted and said that she had to screen it. Little did I know that they would then have a retrospective of Liang’s work and he would come to London. It was a small but perfectly formed festival, which is how these looks at national cinema should be.

At first glance, I didn’t know what to make of the poster which seemed like a lot of undecipherable elements around an alien looking sea creature. Then Huimi informed me, “We wanted the poster to be as cute as possible.”

The poster designer, Ting Cheng, was also at the opening night party added, “She wanted something that would represent Taiwanese culture. I wanted something multicultural, and so we got a sea monster drinking Bubble Tea that is made up on the Taiwanese alphabet, which is full of symbols and these different shapes are representative of different cultures.”

Huimi adds, “You cannot define Taiwan in one shape, so every year, the festival will take on different forms, and that is why the sea monster is significant.”

All of a sudden, the poster took on a profound meaning that I’d not been able to see. It was a good reminder, not just of the value of art, but the importance of listening to others, and, of course, reading critics to elucidate and fill in gaps of knowledge. 

CPH: DOX 

Festival Head: Tine Fischer

“The posters for me are part of the core DNA of the festival. I’m so involved in the posters in a way that drives people mad. When we started working, we had external graphic designers, and now I hire designers so that they are employed inside the organisation and work with me for months! Each time I used agencies, I ended up being in massive conflict with them, mainly because, for me, it’s so delicate what you do with posters. When you said posters, I thought this is so fucking spot on, because it’s a nightmare each year, really a nightmare, because it’s challenging to find the balance in the posters from what I believe is the core DNA, namely a very active civic voice when it comes to political activism. You’re addressing something that people need to react to, not only will this look nice emotionally, but really react to it politically. Then it also needs to reflect an artistic profile that deals very much with non-fiction as cinema and as art. It can’t be a poster that will resemble an NGO perspective. So that balance has to be that it’s highly political and activist but also speaks with a more contemporary art, conceptual language. Then it needs to appeal to our audience, which is from young hipsters to grown-up decision makers. It’s a headache because it’s so difficult.”

“This year, I worked with the same graphic designer that I worked with for the last few years. So he works in-house for half the year, being a part of the process and understanding what the film process is about, but also what kind of films we will have. He saw climate change would be a big issue, but how do you do a poster on climate change? That’s almost impossible as all images relating to climate change have been used and overused. Then he came up with this image, with a woman’s breasts that have been sunburnt basically, but that makes it delicate to put out in public. It’s not overly clear what it’s about, but it is about someone who is not careful. We have the Morse code symbols on it to reflect a universal language, and then some images show images of climate change, there is a lifebuoy for example. There are lots of messages in that picture.”

I had started to feel like I’d seen most approaches to festival poster design, and just as I was beginning to tire of asking festival directors about it, CPH: DOX’s Tine Fischer blew me out of the water. But that will come as no surprise to anyone who has watched the festival over the years. She has taken the bull by the horns during her long tenure at the festival. She boldly changed the dates of the festival from the Fall to the Spring when she felt that the market was too crowded. The film choices have been radical, and she’s established CPH: DOX as one of the most exciting documentary festivals. 

The festival was also where I conducted one of my favourite interviews of the year, sitting down with Alex Winter. We discussed Bitcoin and The Panama Papers, as well as sexual abuse in the film industry. And of course Bill and Ted, we drank coffee together a couple of days after the announcement that he would appear in Bill And Ted 3. Of course, it was most excellent.

Panama Film Festival 

Artistic Director: Diana Sanchez

A few weeks before the Panama film festival took place Toronto International Film Festival announced that Diana Sanchez would be taking up a position in Toronto full-time. Much of Sanchez’s fantastic reputation that led to that Canada role has come from how she built up the Panama Film Festival into one of the most vibrant, forward-thinking and fun festivals in the Americas. Of course, from my side, it helped that Panama is home to Geisha Coffee, some of the best and most expensive beans on the planet. A competition-winning brew that would set you back $75 a cup in San Francisco retails for $9 in Panama. It’s still a lot to pay for a coffee, given that great blends retail at $4 here, but it’s not often that one can treat yourself daily to the champagne of the coffee world. The coffee and the festival were marvellous. This year it gave a great platform to films from Guatemala. It showcased how artists are trying to comprehend the human catastrophe caused by the years of dictatorship and, also the American support to the dictatorship. There is a similar sentiment in Panama where President George W. Bush ordered an invasion in December 1989.

In total contrast to the approach in Copenhagen, Diana Sanchez, in a somewhat more laidback manner, informed me that she didn’t get involved in the production of the poster. She is someone who knows what she likes to do and is happy to delegate the other jobs to others. She advised me to chat with Pituka Ortega, the Director and founder of the Film Festival, who was involved in the creation of the poster and appointed the new team that will be in charge of the 2020 edition.

“It’s the first time that we have worked with Cisco Merel, a Panamanian artist to create the poster,” Ortega says. “He works with geometrical shapes, and one of his masters is Venezuelan artist [Carlos] Cruz-Diez. When we spoke to him, he brought this concept to us that within these geometrical shapes that conveyed cinema. Artists are artists, and we just loved it and went with it. It’s a detachment from everything else we have done, and we loved working with an up-and-coming artist. It has opened a window for us to work with other up-and-coming artists from Panama. The unifying factor will be the logo. It represents the festival as a platform for new ideas and talent just like we are doing for a central American and Caribbean platform that we have invested so much energy and thought to, and our resources. ”

CineMAS 

Artistic Director Joe Wihl

Formerly, the United Arab Emirates was host to not one, but two great festivals. Then in 2015, the Abu Dhabi Film Festival closed after eight editions, and last year, far more surprisingly, the Dubai Film Festival closed. Fans of cinema in the UAE went from boom to bust. So it was great to see cinephiles take the matter into their own hands and launch an independent film festival at an excellent venue, Manarat Al Saadiyat (the MAS in CineMAS). It was a film festival designed by cinephiles for cinephiles that lasted a joyous four days, with master classes, workshops and screenings. The festival is a demonstration that good taste can be more valuable than finance.  

“The poster was made in Abu Dhabi by a branding agency who designed all our collateral,” Wihl told me. “We wanted a poster that connected film, cinema and the art world. We are lucky to show films that people don’t normally get to see, so we wanted it to reflect the artistic nature of the festival. The branding agency came back to us with three options, and we chose the one used because the brush strokes showed the interconnecting nature of the art world and film. We have five different colours that we used on the posters to reflect the diversity of cinema and the wide selection of films from around the world.”

Admittedly, it is hard for me not to like the festival director, since I played on the same soccer team as him for several years. He scored many goals in his time, so I wanted to go to support the festival. This festival may end up being a one-off, as rumours abound that Abu Dhabi may re-launch an international festival in 2020. But many rumours circulate here. 

Cannes 

Festival Director: Thierry Frémaux

Cannes makes a massive fanfare out of its poster. It is published before any film announcement and widely shared on social media. Arguably, this year’s poster featuring the recently departed French legend Agnes Varda was the most popular one-sheet in its history. And that is saying something! A great article by Sight and Sound’s Isabel Stevens argued: “Cannes has finally woken up to the power of the poster.” She posited that the photo-shopped reinterpretation of the iconic image of Varda standing on top of cinematographer Louis Stein when filming her first feature La Pointe Courte was created to demonstrate that Cannes is changing. Stevens argued, it “signals that the festival has, at long last, clocked that it needs to change. Does this change go deeper than a clever and overdue rebranding exercise? Only the number of female-directed films in future editions of the festival will tell.”

Sadly, not long after the poster release, the competition announcement came, and this change seemed to be an illusion with complaints circulating about the lack of female directors. The festival still snagged the best film of the year, Parasite, and one of the many joys of the film is the range of great posters that Bong Joon-Ho’s film has inspired by regional distributors around the world.

As for the likeable Frémaux, every year he proves how good he, and his team, are at their job of selecting the year’s best films. Nonetheless, using a classic image from the past shows how much he still looks back when so many people are crying out for him to look to the future. He is an enigma, just like his festival, whose policy to exclude films not guaranteed an exclusive first run in French cinemas seems more and more robust with every passing year. So far, it’s Netflix and not Cannes making changes to how they operate. 

Kultur Symposium Weimar

By June, unsurprisingly I had had my fill of film festivals, so it was a delight to be invited by the Goethe Institute to attend their second Kultur Symposium Weimar. It was an invite-only event that contained talks, performance art, films and debates.

For three days, more than 300 participants from all over the world came together at the Kultursymposium Weimar, including representatives from science, culture, politics, business, journalism and publishing. The first Kultursymposium Weimar took place in 2016 on the subject of The Sharing Game – Exchange in Culture and Society. The second edition from 19 to 21 of June 2019 was entitled Recalculating the Route. It was an incredibly inspiring event, and great to be somewhere where I did not see the same faces, and people were talking about social issues without the conversation being bound to a film. I also didn’t talk to anyone about the design of the poster for the event. Indeed from this point on in the year, my observation on the one-sheet became largely my own again. This event felt like a real marker separating the first part of the year focussing on the branding to the second part of the year, informed by trying to reconnect with the idea of looking at how film festivals relate the realities of the world and present the future. Of course, there were movies, but this event was really about new ideas and building better social groupings. 

London Indian Film Festival

Festival Director: Cary Rajinder Sawhney

The London Indian Film Festival celebrated a decade. It was a big year for Festival Director Cary Sawhney as he also collected an MBE for services to the film industry. His work is getting noticed. I dipped my toe into the festival attending a screening of The Flight, where it was my pleasure to be asked to host the Q and A with legendary Bengali Filmmaker Buddhadeb Dasgupta. It was a lovely event held at the Cine Lumiere in London. It reminded me how lucky I was to be living in London, where almost every night there is some great film festival of some sort or some fantastic filmmaker giving a talk. For the festival to reach ten years, and be more significant than ever, takes some doing.

Oh and I don’t think I looked at the poster. Sorry, Cary! And, really I need to stay in my home time more often! 

Nordic Youth Film Festival

Festival Director: Hermann Greuel

Having started the year in Tromsø, for a week when the sun never rises above the horizon, it was nice to be back in the Arctic Circle for NUFF when the sun never dips below the horizon. I mean, it’s cold whatever the time of the year one is in the Arctic, but on a clear day, when you can actually glimpse the sun it is gorgeous. At NUFF, the efforts to build a politicised film community are what brightens-up every day of this youth orientated festival.  

NUFF is an annual short film festival and film workshop for young filmmakers up to the age of 26. These talents get split into several groups under the guidance of a filmmaker. They have a week to make a short film from scratch. On the final weekend, the freshly made short films screen as part of a short films festival. The mentors included producer Racha H Larsen and filmmaker Egil Håskjold Larsen, whose film Where Man Returns opened the Tromso International Film Festival. The prolific award-winning short filmmaker Mahdi Fleifel, Anders Emblem, whose film Hurry Slowly I had missed at Tromsø International Film Festival but saw at a special here. Inuk Jørgensen from Greenland and Virtual Reality expert Marta Ordeig were also in charge of a group, and composer Rune Simonsen was producing music for the images.

I delivered a film appreciation seminar and hosted a masterclass event with Mahdi Fleifel talking about his short films, which we screened in chronological order, as well as hosting Q&A sessions with some of the talents attending the workshops It was an awesome time!

Festival director Hermann Greuel is such a great personality and so friendly. I wish that I could wipe away the years, and be young enough to be accepted as one of the participants. It’s a truly great event, and one that seemed to be practising the philosophy preached at the Weimar Kultur Symposium. The future is sunny. 

Karlovy Vary Film Festival 

Festival Director Karel Och

Karel Och is one of the great festival directors of our times. He has good taste, hosts a well-respected film festival that has great talents, juries, parties and writing courses. So what’s not to like? Well, somehow on the first night I was put into the world’s most noisy hotel, above a party that went on until 4 am every night. Add to this that the Internet in the basement house in Parasite worked better than it did at the hotel and I wasn’t a happy camper. Thankfully, the next night they moved me to the edge of town, and the smile returned to my face.

Apart from that blip, I saw many unique films. HBO put on a great party. I’d seen so many films at Cannes, that I wasn’t as side-tracked by catching up with Cannes movies as I have been on past visits to Karlovy Vary film festival. It’s a great place to get a taste of films from Eastern Europe and the Middle East. There was an excellent retrospective taking a look at the works of Egyptian maestro Youssef Chahine films. Even though I haven’t been for a few years, the festival seems familiar. Even the poster for the festival is the same design, this year the colours were changed to be black and white. So why is it, that I always leave Karlovy Vary with a but…

Every time I get home I think I’ll give Karlovy Vary a skip next time. But that’s usually because every second year clashes with a big soccer tournament. The festival will be happy that in 2022, the world cup is moving to the winter because of the hot Doha summer, that will probably be the year I’m not invited! The festival has a great press dinner, and at the main festival centre, there is a bar where everyone congregates. However, the festival still manages to get it wrong because it separates the industry, press and guests from each other. There feels like several festivals going on at the same time, which is a shame as really Karlovy Vary should be about breaking down those barriers between the different parts of the film community rather than reinforcing them. 

Locarno Film Festival 

Festival Director: Lili Hinstin

Locarno feels like a bit of a blur. It was the first year that Lili Hinstin was in the Festival hot seat. Her philosophy seems to be that evolution and not revolution was the best way to get her feet under the table. On my first night by the magnificent lake, I met her at an official dinner attended by Palme D’Or winner Bong Joon-Ho and also hosted were those programmers and filmmakers who put together the excellent Black Light retrospective. On the Industry side, the push to support filmmakers from around the world, especially from those areas without traditional support for independent cinema remains strong.

The poster also evolves slightly every year, but it noticeable evolved that little bit more this year, the main indicator of changes. What I like about Locarno is the use of the yellow and black leopard spots, which are always such a unique identifier. It’s also fun. There have been some inventive variations on the leopard theme, especially the kiss poster from the 59th edition in 2006, which remains one of my all-time festival favourites. This year, there was a bold reinterpretation that saw far more playful brush strokes, creating a more abstract version of the leopard, but one that seemed more playful, child-friendly and looking to the future. With it being Lili’s first year, it was understandably difficult to find time to catch her for a conversation on the direction of the festival, which I’m looking forward to doing in 2020

Locarno is a festival that has so much going for it, from the magnificent screenings in the Piazza Grande of more commercially minded films to the selection of more challenging fare in competition and elsewhere. Yet, as with so many other festivals, it has suffered from sales agents no longer using the film festivals as their primary location to source and sell movies. It will be interesting to see how Karlovy Vary and Locarno tackle the hurdles ahead, especially on the side of promoting cinema rather than movies. Festivals such as Locarno and Karlovy Vary have begun addressing this issue by being more supportive of a broader range of critical voices. Still, there must be more effort to make audiences feel part of the movie industry and encourage spectators to make bolder choices, not just at film festivals, but on a Friday night date.

Venice Film Festival 

Festival Director: Alberto Barbera

In the last couple of years, it’s been a surprise that the Venice Film Festival hasn’t just found a space to put the Netflix logo in the middle of the poster, given the preponderance of films from the streamer. I get it. Venice has been the primary beneficiary of the stance taken by Cannes on streaming platforms failure to heed cinematic windows, and they have reaped the red carpet rewards, with more stars in attendance and more media interest. It’s undeniable that Alberto Barbera has done a great job in making Venice a place to launch films, especially award contenders. Although it’s likely that for the second year in succession, unless Marriage Story does pull off an unlikely Best Film Oscar victory, that for the second year, the Oscar winner will not have debuted on the Lido. There is also a well-voiced and, quite frankly well-placed, concern about the dominance of English language films in the Venice competition. Again, the media and the trades desire to push films as Oscar contenders, that will result in them receiving advertising money from studios looking to win awards, is also part of the game. So it’s not in anyone’s interest to complain too much. It’s another example of how capitalism can limit choice, even in art.

Consequently, some great movies that could have done with the status push that can come with appearing in competition on the Lido get somewhat lost in the sidebar sections. I would like to see Venice be a bit bolder in its official selection. But if it’s glam you want, Barbera is your man. He is incredibly slick, has a big fun personality and could have been a character in La Dolce Vita. He is Italian Hollywood.

Even the choice of poster, which I love, reflects this debate. It’s a painted image of a couple being filmed kissing on the front of a boat. It’s a hint towards Titanic more than the refugee crisis, or the debate about how locals have turned against cruise ships, and the worry about climate change. The poster designed by Italian illustrator Lorenzo Mattotti (he’s also created the 2000 edition Cannes poster) emphasizes the water that makes Venice so unique, and the painted image connects the film festival to La Biennale, of which it is part. I liked the poster, and yes, I liked the festival. 

Toronto Film Festival 2020

Artistic Director and Co-Head: Cameron Bailey

I must admit it’s only now that I’m writing this that I’m looking properly at the one-sheet of the Toronto International Film Festival for the first time. The fall film festival season doesn’t allow for much navel-gazing. It’s the moment every year that I forget the sage advice from Ferris Bueller’s Day Off about life moving pretty fast and the need to take stock and look around once in a while. At Toronto, there is no such opportunity to stop. After the curated programmes of Venice and Telluride is the splurge of films in Canada.  The festival ends with the announcement of the winner of the Toronto audience award. Then we are all supposed to guess what will win the Oscars for the next few months. Of the Oscar frontrunners, only 1917 and The Irishman, which debuted shortly after at the New York Film Festival had not screened at this stag. It’s a shame that there is this enormous focus on what goes on in Hollywood in February because great stuff that happens in Toronto gets overlooked as a consequence.

One of which is the mentoring of film critics from underrepresented demographics. So at TIFF, I had the great honor of mentoring Valerie Complex at the festival. It was great to be able to meet up and hang with a young writer, who had exciting and differing viewpoints about films. She’s also making significant headway into the field of criticism, and has a prevalent Twitter account should you want to employ her. Together, we watched Anna Winocour’s space training epic Proxima, which we were still debating the next day. It was a film that grew on both of us, with Complex being the first to admit that the film was better than she initially thought. The joy of movies and not writing immediate tweets and reviews. As with many things in Toronto, it did feel like the critic mentoring scheme was another thing added, and need some refinement and more support from the festival, but it’s a great start for the initiative that I hope will grow. It came as no surprise to me that this initiative was taking place at a festival where Cameron Bailey is the head honcho. Despite all the talk around inclusion, white male critics still have so much more opportunity than women and people of color. And it’s no surprise that Bailey has overseen this initiative given his background. He’s a top programmer, and it won’t be long before his evolution at TIFF becomes a revolution. Of the big fall festivals, Toronto is the one making the most significant effort to bring about change not just to film, but also society.

But back to that poster, it’s a bit abstract and difficult to tell what it wants to be. Maybe I did see it during TIFF, everywhere, I just didn’t realise that it was the visual identity that was supposed to be representing the festival. Having said that, it kind of fits with some of my sentiments about a festival where a lot of films, seem to be put together abstractly, and where it doesn’t quite come together as a whole.

El Gouna Film Festival 

Festival Director: Ihtishal Al Timimi

I have a good rapport with Festival Director Ihtishal Al Timimi from his time at the Abu Dhabi Film Festival. Heading to Egypt meant that I had to miss San Sebastian, one of my favourite film festivals of the year, every year. I’m still crying, even if it was well worth the change of water and sun location. El Gouna is one of those friendly festivals, with a real hub where everyone mingles and chats about the movies that they have, or haven’t been watching. Its focus is on films from the Middle East and North Africa, and all of the key players from the region turn up, make plans and plot for the future. It comes a few weeks before Cairo and has a far more curated programme in which most films had a lot going for it. It was one of those festivals with not much to do in a resort late at night, so it was easy to mingle with filmmakers and festival programmers.

The poster is striking, albeit one more in keeping with it a perfume fragrance rather than a film festival. It shows a lady in a red dress walking across a stage from left to right, with the backdrop resembling a film reel. It wants to be modern but can’t help but feel retro. Much like this festival, the poser is a throwback to a bygone era, and that’s not always a bad thing. I’m hoping the festival moves dates to avoid a clash with San Sebastian in the future.

Zurich Film Festival 

Artistic Director: Karl Spoerri

Straight from El Gouna, I crashed into the Zurich Film Festival. This festival, with its green carpets, has been growing in stature every year. It’s the sister festival to San Sebastian and benefits from filmmakers coming straight from the Basque region to Switzerland. Zurich has improved a lot in recent years, but the selection has yet to catch fire. The big Swiss festival, Locarno, has a much more progressive and diverse programme. This year was a watershed for Zurich in many ways as it was the final year that co-founders Nadja Schildknecht (managing director) and Karl Spoerri (artistic director) were at the helm. They will be board members and advisors to the festival from here on in. Some months before the festival started, Zurich announced that leading film journalist Christian Jungen, the chief cultural editor at the German-language Swiss newspaper NZZ am Sonntag, had joined the Zurich Film Festival and would take over as Artistic Director in 2020. The appointment shows that good taste and a long career observing the film industry is still a way into festival curating (despite my earlier observation), especially for celebrations of cinema looking to be bolder in their selection.

One of the changes that can immediately be made, that would highlight a bit more risk-taking, is the creation of more captivating movie posters. I hope Jungen changes this up too. The Zurich Film Festival has a strong logo presence, but the desire to have a visual identity that appears on tickets, festival cars and stationery has led to the uninspiring and corporate logo dominating the festival poster. Where is the fun? The use of the logo on the poster is more bland corporate identity than art. Let’s face it, the formula for many film festivals is the same, you have films, industry talks and events with a bit of glamour on the carpet, it’s the other stuff that stokes the audience imagination that creates buzz. That starts with a good poster.

London Film Festival 

Festival Director Tricia Tuttle

The London Film Festival also went for the abstract approach to designing their visual identity. At first glance, it feels even more abstract than that in Toronto and less cohesive with it’s merging triangles and colours. The British Film Institute said when launching the poster: “Delivered in collaboration with creative agency DBLG, the design continues to develop iconography that was inspired by the beautiful NFT sign on our building at BFI Southbank, which was created in 1957 by Norman Engleback, and harks back to some of our classic Festival artwork from the 60s.” Hmm. If you say so! I’ve been to the BFI Southbank building countless times, and I’m at a loss about the beautiful NFT sign! 

London is my hometown film festival, so I guess that makes me harder on it, in the way that happens in families. It was the first year that Tricia Tuttle was officially in charge as festival head. The year before she was acting head, so 2019 wasn’t her first festival in the hot seat. Her promotion seemed to be an anointment rather than an appointment. I was surprised that there was not a more significant fanfare about the failure to open up the application process, but not too surprised. Tricia is very personable and is well-qualified for the role and probably would have got the job anyway. Also, it’s hard to imagine many clamoring for a position that involves programming a festival around talent that is coming to London for BAFTA screenings so that they can campaign for award season votes. London feels like a hostage to the awards season. 

That being said the clamoring for votes is terrific timing for the festival as it means it gets a host of talent to attend the festival because it’s the early stage of the awards campaigning when producers and studios are still unsure of what will emerge as the frontrunners. Consequently, it struggles to be a festival of discovery or even a festival of festivals, despite the introduction in recent years of competition segments. The surprising omission of Nadav Lapid’s Synonyms meant that this was the first time that I can remember that none of the Berlin, Cannes, or Venice Best Film winners played at the festival. (Someone will no doubt fact check this and prove me wrong!) 

As with any festival that has this many films and star names, the attention gets placed on the usual suspects. While film festivals are the life-blood of smaller independent films, it is harder than ever for them to emerge and break out into the mainstream. It’s a chicken and egg situation. London does try to make this push, but the sheer size and scale of the operation, and the need to get audiences through the door means it usually fails. How hard it is for films to get noticed is the struggle of our times, and it’s even harder persuading a distributor to release it after a festival appearance, which sounds odd given that more movies are coming out each week than ever before. London is just another festival that seems to favor the studios rather than the independents, as it’s easier to get bums on seats and ticket sales for blockbusters, even if the goal is to highlight smaller films and BFI funded films. However, I realize I know I’m more aware of the issues of the festival in regards to the distribution scene in the United Kingdom, as I’m much more often in contact with the local sales agents, distributors and exhibitors, which could be highlighting the problem. I’m sure the same story is being told elsewhere, but it is one that comes into sharp focus for me in London.

Lumière Film Festival 

Festival Director: Thierry Frémaux

When not presiding over Cannes, Thierry Frémaux is the director of the Institut Lumière, in Lyon. The museum and the festival are located within the grounds of the Lumière family house, around the site that the Lumière brothers shot one of their earliest works, Workers Leaving the Lumière Factory in Lyon. It’s often called the first motion picture ever made. The Institut Lumière was founded in 1982, and charged with promotion and preservation of film. Acclaimed French filmmaker Bertrand Tavernier is President and Frémaux is its director. It’s a job that Frémaux clearly loves. One of my best experiences in a cinema was watching Frémaux live-present Lumière! A film he directed in 2016, made up of clips and reels of early French cinema. The witty and engaging commentary that he delivers as the reels play is extraordinary and full of passion.

A decade ago, Frémaux decided to launch the Lumière Film Festival, which focuses on the history of cinema with a line-up dedicated to restored prints and retrospectives. There are some new films, presented when one of the many luminaries who come through the festival give a masterclass. Top talent comes, because of the connection to Cannes. The masterclasses are extensive, intriguing and unique, some of the best of the year. Go on their website and listen to the podcasts if you have not done so already, you will not be disappointed. It’s impossible not to have a fabulous time when spent watching the works of Lina Wertmüller, treasures from pre-code Hollywood, and re-mastered classics including 5 Fingers by Joseph L. Mankiewicz and Phillipe Garrel’s Liberty at Night.

The Festival poster is in keeping with the cinematic history theme. It’s a poster of Francis Ford Coppola directing on the set of Rumble Fish. It’s in black and white, of course, and chosen to celebrate the fact that Coppola was in town to pick up the festival’s big honour, Prix Lumière. Coppola had a great time. My particular highlight was seeing him introduce The Cotton Club. A couple of days later at The Godfather Trilogy all-nighter, I was struck by how The Cotton Club and The Godfather movies use entertainment as a mask for nefarious activities. It is a great film festival, and a joy to see cinema through the eyes of Frèmaux, in a way that is impossible at Cannes. Bravo!

Red Sea Industry Workshop

Red Sea Festival Director: Mahmoud Sabbagh

The decision to allow cinemas to open in Saudi Arabia after a 30-year ban has brought a vast new audience and film market hungry for cinema. Saudi Arabia, with a population of around 70 million, is full of cinephiles. The cinemas that have been opening have been booked out. There have also been several Saudi films that have started to appear at film festivals. Haifaa Al Mansour’s The Perfect Candidate vied for the Golden Lion at the Venice Film Festival. The observational comedy Barakah Meets Barakah by Mahmoud Sabbagh is one of the most popular films from the region on Netflix. It is Sabbagh, a pioneer as a director, who is leading the drive to set up the Red Sea Film Festival, and also the Red Sea Lodge, an incubator for regional filmmakers that’s been set-up in collaboration with the Torino Film Lab. Two of the projects will win a production grant of $500,000. Next year, the Red Sea Film Festival will have its inaugural edition in March.

I jumped at the chance of going to the Old Town in Jeddah for the weekend to meet the filmmakers from the 12 projects selected for incubation. The filmmakers seemed invigorated at workshops where leading industry experts were discussing and dissecting their scripts for just over a week. I watched enthralled as one workshop leader used toys to highlight character journeys and some structural problems. Egyptian filmmaker Marwan Hamed delivered a masterclass, where he discussed his career, including the adaptation of The Yacoubian Building. I was most impressed by the attendance, where the local community sat enthralled throughout and came armed with interesting and intelligent questions. It was a surprisingly more engaged audience than I had seen at other Middle East Film Festival over the years. Cairo usually being the best. 

There was no poster as such, although on the literature that was released, often the writing would come over a photographic image of the Unesco heritage site in Old Town Jeddah. It will be interesting to see what happens in March when the first edition launches. Will the festival be seen as Saudi filmmakers celebrating film for the first time in three decades or will it be clouded and judged by a geo-political narrative? Much will be in the eyes of the beholder.

Films From the South 

Festival Director: Lasse Skagen

I found myself in Norway again, this time in Oslo for Films From the South Film Festival, where I delivered a master class at the Sørfund Pitching Forum on “Festival and Press strategy” to Norwegian producers, international directors and producers. At Sørfund Pitching Forum six selected filmmakers from Latin America, Africa and Asia pitch their films that they hope will be backed by the Norwegian film fund in 2020. One of the great advantages of this fund is that you don’t have to invest the money in Norway, but you need to woo a local producer, who will then be your Norwegian co-production partner. The standard of filmmakers is extraordinary. Two of the filmmakers pitching at the event had won Lion of the Future awards, for best first film at the Venice Film Festival.

So I didn’t attend a film at the Films from the South Festival. This was a festival that for me was about helping filmmakers further their career. In Oslo, I was the one in control of the show, or more accurately the Powerpoint presentation. It’s great to talk to filmmakers directly in this way. The aim of the talk is to give them an idea of a strategy that might attract the media to their films, including which festivals they might get the best results at, and when or where they will need to employ publicists, find sales agents, or just do it on their own. It always amazes me that independent filmmakers have to be both architects and realtors, they plan, create and when they have finished their film, they then realise that it’s up to them to sell their films. Even if they have a great team behind them, or working with them, often festivals can be a confusing and demoralising place for a filmmaker. 

I looked through the Films from the South catalogue, and it was an impressive list of films that were screening, and Sørfund can be proud of the success the films they’ve funded have had, especially last year. The screenings highlight how there are so many great filmmakers around the world, and how much stimulating and fascinating work gets created each year. On the minus side, it’s demoralising to see so many amazing films get ignored. As for Lasse Skagen, who is also the Artistic Director at the Oslo Festival Agency, and has been at the Oslo Films from the South Foundation since 1997, our paths didn’t cross, but I admire his work. I was in contact with the SORFOND team. As for the poster for the festival, I have only just looked at it now, and have to say I like it. A rainbow of paint is segmented to show the sun high in the sky casting a shadow down to the sea, a clear distinction of the world between the North and the South. Although some may balk at my interpretation as it can also be looked at as a representation of privilege. 

Ajyal 2019 

Festival Director: Fatma Al Remaihi

If you have made it this far, I salute you. You must be as exhausted as I was by the start of December. For my last festival of the year, I was back in Doha at the Ajyal Film Festival. This time it didn’t seem like Fatma Al Remaihi and Hanaa Issa argued very much about the poster, as it was in the spirit of the posters from previous edition, featuring an explosion of colourful splintered geometric shapes creating a circle with no borders. The use of the white background, a change from the previously used black background, made it pop out even more.

It’s been a few years since I’d been to this festival, and I have to say I was very impressed with how much better it is now, then from it’s baby years. Ajyal’s excellent goal is to foster a love of cinema in children and young adults. There are 96 films screened from 39 countries, with the juries for these films made up of these young spectators, split up into various age groups. Each age group were given 4 to 6 movies to watch and judge. There were also workshops for the 400 jurors from 41 nationalities, including 40 international jurors. 

I delivered a quick talk on how to watch movies and criticize them. What was surprising was how little help they needed, and that they were open to the fact that film criticism can come in many forms these days, not just print, but also with memes, video streaming and just chatting to your friends over a milkshake. It was the perfect end to an exhausting year, and as I finally finish writing this up, I realise that I went to a hell of a lot of events last year, and it’s impressive how non-repetitive and unique each festival is.

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When and where you can see a historic steam train travel through Cambs – Cambridgeshire Live

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A historic steam train will be travelling through a part of Cambridgeshire this year, giving train buffs a chance to see the iconic locomotive.

Ely station will be treated to a rare sighting of one of only two surviving B1 class locomotives.

The train will be passing through the station on April 11, 2020, on its journey from London to Lincoln – where passengers will enjoy a day out in the cathedral city.

The 63106 Mayflower will also be passing through several other nearby stations including Ipswich and Bury St Edmunds (as well as others listed below).

Steam train enthusiasts can buy tickets to ride it to Lincoln, or simply visit the stations it passes through to catch a glimpse of the magnificent machine.

Find out more about timings and the train’s exciting history below.

About the engine

Abigail Rabbett

As reported by our sister title EssexLive, the 63106 Mayflower is one of only two surviving B1 Class locomotives, designed to haul either express passenger trains or freight traffic.

She was built in 1948 by the North British Locomotive Company in Glasgow and first deployed in Hull, before being transferred to Bradford.

Mayflower was the last B1 in service, with her final trip spent hauling the ‘Yorkshire Pullman’ from Leeds in September 1967.

The train was restored in the 1970s, acquired by Steam Dreams owner David Buck in 2014 ad returned to mainline service in 2015, before being withdrawn for an extensive overhaul.

Where can you see it?

Here are the times the train will be passing in and out of Ely and nearby stations on its journey:

For more information and tickets for the journey, visit the Steam Dreams website.

Follow Social Media Editor Abigail Rabbett on social media

To follow Abigail on Twitter, click here.

To like her Facebook page and keep up to date with the latest breaking news, press here.

Or simply visit Cambridgeshire Live’s main Facebook page here for all our latest stories.

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EBB 117 – The Evidence on Inducing for Due Dates – Evidence Based Birth®

person

Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing labor for going past your due date.

Welcome to the Evidence Based Birth podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing versus waiting for labor when you’re going past your due date. I’m going to be joined by Anna Bertone, MPH, our Research Editor at Evidence Based Birth to talk about this topic.

Before we get started, I have a quick announcement, and that is next week we are hosting free webinars for the public all about the Evidence Based Birth Childbirth Class. On Monday, March 2, we’ll host a special webinar just for parents. We’ll give you a peek behind the scenes at what it’s like to take our Evidence Based Birth Childbirth Class. Then on Tuesday, March 3, we’ll have a special webinar just for birth professionals to give you a tour of the Evidence Based Birth Childbirth Class so that you can decide if it’s something you’d like to recommend to your clients or not. You can register for these free webinars at evidencebasedbirth.com/childbirthclasswebinar. That’s all one word /childbirthclasswebinar.

All right, now back to the topic at hand, inducing labor for going past your due dates. Now before we begin, I do want to give a brief trigger warning. In our discussion about the research evidence on this topic, we will be talking about stillbirth and newborn death. So there has been a ton of new research on the evidence on induction versus waiting for labor when you go past your due date. So much research, in fact, that we have decided to separate our Signature Article on due dates into two separate articles.

So we still have the original article, The Evidence on Due Dates, which you can find at ebbirth.com/duedates. And although we updated that article a little bit, it’s remained very similar to previous additions. It talks about the length of a normal pregnancy, factors that can make you more or less likely to have a long pregnancy, et cetera. But then we separated out the research on induction into a new article that you can find at ebbirth.com/inducingduedates. This is a peer-reviewed article that covers all of the research on induction versus something called “expectant management” for going past your due date. And in today’s podcast, we’re going to update you on the latest info that we found for that article.

Just a heads up, we will not be covering the research evidence on inducing at 39 weeks. We already covered the ARRIVE study, a randomized trial that looked at induction versus expectant management for 39 weeks of pregnancy in episode 10 of the Evidence Based Birth podcasts. And just a tip, if you’re having trouble finding any of our earlier episodes of this podcast, iTunes has stopped showing the earliest podcasts, but they’re still out there and you can find them on Spotify and any other podcasting app. You can also find info about the ARRIVE study at ebbirth.com/arrive.

So we’re not going to talk about induction at 39 weeks. Instead, we’re going to be focusing on the evidence on induction versus waiting for labor once you reach 41 weeks. And to do so, we’re going to talk with our Research Editor, Anna. So welcome, Anna, to the Evidence Based Birth podcasts.

Anna Bertone:   Thank you! I’m glad to be on the podcast again.

So I want to start by explaining to our audience a little bit kind of about the background of why this topic is important. Inductions for non-medical reasons have been on the rise in the United States and all around the world for the past 30 years. And increasingly, more people who are pregnant are being induced for reaching their estimated due date. So we really want to cover the benefits and risks of elective induction for going past your estimated due date. And we’ll also talk about whether or not your goals and preferences for your birth matter, which of course they do, but that kind of plays a role as well.

So how often are people induced for going past their due date? Well, we don’t know for sure because this hasn’t been measured recently. But according to the 2013 Listening to Mothers III survey, which was now published about seven years ago, more than 4 out of 10 mothers in the U.S. said that their care provider tried to induce labor. Inducing labor for going past your due date was one of the most common reasons for an induction. Out of everyone who had an induction in this study, 44% said they were induced because their baby was full term and it was close to the due date. Another 18% said that they were induced because the healthcare provider was concerned that the mother was overdue.

The Centers for Disease Control in the U.S. also reported in 2018 that about 27% of people had their labor induced, but we think that number is probably low and that the percentage of people who have labor induced is under-reported in the Vital Statistics Program in the United States. So Anna, can you talk a little bit about why there’s so much controversy over this concept of electively inducing labor once you go past your due date?

Anna Bertone:   So why is there so much controversy about elective induction? Elective inductions by definition are labor inductions that do not have a clear medical reason for taking place. They occur for social reasons, like the provider wanting the mother to give birth before the provider goes out of town or for other non-medical reasons like the pregnancy getting uncomfortable and for the mother’s convenience. But there’s also a gray zone about what constitutes an elective induction. Many providers only consider an induction to be “elective” when the mother is healthy, pregnant with a single baby, and less than 41 weeks pregnant. The gray zone is that sometimes when the pregnancy goes past 41 weeks, some providers consider that to be a medically indicated induction rather than an elective induction. But in general, inductions are considered medically indicated when there are accepted medical problems or complications with the pregnancy that make it less safe to continue the pregnancy.

For many years, and I remember when I first entered the birth world in 2012, a lot of people talked about the fact that if you have an induction it doubles your chance of cesarean. And then all of a sudden there were people saying that wasn’t true. So can you talk a little bit about that controversy?

Anna Bertone:   So for many years, the common belief was that elective induction doubles the cesarean rate, especially in first-time mothers. But researchers nowadays consider those earlier studies to be flawed. In the earlier studies, what they would do is they would compare people assigned to elective induction to people who went into spontaneous labor. Nowadays, they don’t compare those two groups anymore. They compare people assigned to elective induction to the people assigned to what’s called expectant management, or in other words waiting for labor. And in that group, the person could either go into spontaneous labor or they could require an induction for medical reasons (so that would be a medically indicated induction), or they could choose elective induction further along in the pregnancy.

So that’s a subtle difference but an important one because in the earlier studies they compared elective induction to spontaneous labor. But you don’t have the choice to go into spontaneous labor today. Your choice is to be induced today or to wait for labor to start. And sometimes during that waiting period you might develop complications that require an induction, or you might change your mind and decide to have an elective induction, or you might go into spontaneous labor.

Anna Bertone:   Right. So nowadays, we compare a group assigned to elective induction to a group assigned to expectant management. One example of this was the ARRIVE trial.

The ARRIVE trial was a study comparing elective induction at 39 weeks versus expectant management. We’re not going to go into that trial in detail because we already covered it in detail in episode 10 of the Evidence Based Birth podcasts. But they actually found a lower risk of cesarean in the elective induction group. Researchers think that had to do with the fact that of the people in the expectant management group, more of them developed problems with blood pressure that required medical inductions and increased risk for complications. So again, that just kind of goes to show you that it does make a difference when you compare elective induction to expectant management.

Although, one thing you have to keep in mind with the ARRIVE study is that they had a very low cesarean rate in both groups compared to some settings. The cesarean rate was 19% in the elective induction group versus 22% in the expectant management group. So those research results cannot probably be generalized to settings with extremely high cesarean rates or high cesarean rates with inductions. We have some, for example, some professional members at Evidence Based Birth who talked to us about where they’re practicing and how high the cesarean rates are with the elective inductions there. So I think you have to be careful how you generalize or apply that data from the ARRIVE study, and we talk more about that in episode 10 of the podcast.

Which leads me to another point, and that is some cautions about the evidence. When I say generalize, that means taking research from a research study, and seeing if you can apply that to where people are giving birth in your community. So it’s important to understand that there are some major drawbacks to some of the research that we’re going to be talking about. Many of the studies are carried out in countries or time periods where there are low cesarean rates. So when that happens, when a study is carried out in a setting where culturally there’s low C-section rates, that might not apply to a hospital with high cesarean rates. If your hospital has high rates of “failed inductions” and strict time limits on the length of labor, then the evidence in these studies may not apply to you because induction might be more risky in your community hospital.

Also, another disclaimer about the evidence, in these trials, people are randomly assigned to induction or expectant management. And it’s important to remember that the people assigned to expectant management do not always go into labor spontaneously. There’s a mix of people in that group. Some of them do have a spontaneous labor. Others have an elective induction later on, and others have a medical induction for complications.

Also, you have to look at what they’re doing for fetal testing in the studies. In some studies there’s lots of fetal testing going on in the expectant management group. However, we’re going to talk about one of the studies where they were not doing any standard fetal monitoring during expected management. So those results might not apply to your community if your community does the fetal monitoring, and the study did not have fetal monitoring.

Finally, another disclaimer about the research evidence is that the induction protocols vary from study to study, and even within studies themselves. So knowing what the protocol was for induction in that study can be very helpful to decide if this is going to apply to your unique situation in your local community or not.

So with all of those disclaimers being said, there’s been quite a lot of new research in the past year about induction at 41 weeks. So Anna, can you talk about one of the most recent studies? Let’s talk about the INDEX trial from the Netherlands. There were two trials that came out in 2019, two large randomized control trials. Let’s talk about the INDEX one first.

Anna Bertone:   Sure. So the INDEX trial was from the Netherlands. INDEX stands for induction at 41 weeks, expectant management until 42 weeks. This was a large multicenter trial. It was conducted at 123 midwifery practices and 45 hospitals. Most of these pregnancies were managed by midwives.

…So this was the midwifery-led model of care-

Anna Bertone:   Exactly.

… which is very different than in the United States which is typically an obstetrician-led care model.

Anna Bertone:   The researchers randomly assigned a total of 1,801 pregnant people to either induction at 41 weeks and zero to one days or to wait for labor until 42 weeks and zero days, which is called expectant management. The reason they were able to conduct this study in the Netherlands and got ethical approval for it is because it was standard practice for them to not induce labor before 42 weeks with an uncomplicated pregnancy.

…Whereas in the U.S. it’s rare to see someone go to 42 weeks, in the Netherlands, they typically won’t induce you unless there’s medical reasons until you get to 42 weeks – 

Anna Bertone:   Exactly. So the mothers were enrolled in the study between 2012 and 2016. Everyone had to be healthy, and pregnant with single, head-down babies. The gestational ages were estimated with ultrasound before 16 weeks of pregnancy. They excluded people with a prior cesarean, with high blood pressure disorders, with expected problems with the baby’s growth, abnormal fetal heart rate, or known fetal malformations (congenital anomalies). In both groups, cervical ripening and induction methods depended on local protocol. It’s like what Rebecca was talking about earlier. There wasn’t a standard protocol to apply to both groups in this study when it came to cervical ripening and induction. It was based on local protocol. And this is an important weakness of the study because the providers might’ve managed labor inductions differently based on whether someone was being electively induced or was assigned to the expectant management group. It also limits the study’s generalizability, which means our ability to apply the results of this study to the population at large because providers don’t have an induction protocol that they can replicate.

…So we can learn from what happened in this study, but it’s difficult for us to apply it to across the board because there’s no specific induction protocol that could be followed – 

Anna Bertone:   Yeah. What happened was in the elective induction group, 29% of the participants went into labor before their induction and 71% were induced. Then in the expectant management group, 74% of the participants went into labor spontaneously before their planned induction and 26% were induced.

…And before we talk about how long the pregnancies were, I think it’s important for people to understand that when you have a randomized controlled trial like this the researchers do something called intent to treat analysis. So it doesn’t matter what type of birth they had, whether it was a spontaneous labor or a medical induction, the data were analyzed depending on which group you were originally assigned to. So if you were assigned to an elective induction but you happen to just quick go into labor on your own before the induction, you were still grouped with everyone in the elective induction group and vice versa. So that’s just an important distinction for people to understand. – 

Anna Bertone:   Yes. What happened with these results is that the median pregnancy was only two days shorter in the elective induction group compared to the expectant management group. This is interesting because they still found a difference between these two groups, but-

…And this is important because a lot of people ask us like, “Well, I only want to wait one more day, or two more days, or three or four more days,” but they’re saying by decreasing the length of the pregnancy by two days they found significant results. So what did they find in the INDEX trial? – 

Anna Bertone:   So for mothers, they found that there was no difference in the cesarean rates. This was taking place in a country with low cesarean rates. It was a midwifery model of care and the rates were very low in both groups (11%). 

They only had an 11% cesarean rate then?

Anna Bertone:   Yeah. They also had an outcome called a composite outcome, which is a combined outcome for mothers, and there was no difference in that measure either. They were looking for things like excessive bleeding after birth, manual removal of the placenta, severe tears, intensive care admission, and maternal death, and they didn’t find a difference in those things. There were no maternal deaths in either group. So as far as the bad outcomes for the mothers, there were about 11% to 14% in both groups, but not different.

…And what about for the babies then? – 

Anna Bertone:   And then for the babies, the babies in the elective induction group had a lower composite outcome rate. And in this composite outcome, what they were looking at was perinatal death, Apgar score less than seven at five minutes, low pH, meconium aspiration syndrome, nerve injury, brain bleeds, or admission to a NICU. And here they found a lower composite adverse outcome rate with the babies in the elective induction group (1.7% versus 3.1%). 

And why do they think that outcome was better with the elective induction group?

Anna Bertone:   They think that it was mostly due to the lower rate of Apgar scores less than seven at five minutes, and that probably contributed the most to having a lower adverse outcome rate with the babies in the elective induction group. The author’s note that there was no difference in rates of Apgar score less than four at five minutes, but they found that the combined outcome was still lower in the elective induction group if they used an Apgar score of less than four at five minutes and excluded fetal malformations. So basically, the babies in the elective induction group had better Apgar scores overall.

…And what about stillbirths? Because that’s like the main reason they’re doing these kinds of elective inductions, is to lower the risk of stillbirth. – 

Anna Bertone:   Yep. And they did not find a difference in stillbirth in this study. There was one stillbirth that occurred in the elective induction group. It was at 40 weeks and six days, before the mother was induced. Then, there were two stillbirths that occurred in the expectant management group while the mothers were waiting for labor.

Anna Bertone:   I looked for a few more details about those stillbirths because I was interested in that. Of the two stillbirths that occurred in the expectant management group, one was a small for gestational age baby at 41 weeks and three days to a first-time mother. The other one was to a mother with a prior birth, and that was at 41 weeks and four days. The mother’s placenta showed signs of infection (infection of the membranes). Then, the one stillbirth that occurred at in the elective induction group at 41 weeks was to an experienced mother (someone who had already had given birth before), and that was at 40 weeks and six days, and there was no explanation for that one. But with two versus one, they didn’t find a significant differences in stillbirths between those groups.

And what was the protocol for fetal monitoring in that study?

Anna Bertone:   There was no protocol for fetal monitoring. It depended on local guidelines, just like the induction and cervical ripening protocol. But the study authors say that fetal monitoring and assessment of amniotic fluid levels was typically done between 41 and 42 weeks. 

So how would you sum up the results of this INDEX study then?

Anna Bertone:   They found that elective induction at 41 weeks resulted in similar cesarean rates and less overall bad outcomes for babies compared to waiting for labor until 42 weeks. However, they say that the absolute risk of a bad outcome happening was low in both groups. It was 1.7% in the elective induction group versus 3.1% in the expectant management group (the group that waited until 42 weeks).

All right. Well, the next study we wanted to talk about was the SWEPIS trial from Sweden, also published in 2019, also coming out of Europe. It’s S-W-E-P-I-S, and it stands for the Swedish post-term induction study, or SWEPIS. It got a lot of media attention with headlines like … There was one that said, “Post-term pregnancy research canceled after six babies died.” And it is true that this study was ended early after deaths in the study. The researchers intended to enroll 10,000 mothers from multiple centers across Sweden, but they ended up stopping the study with about 1,380 people in each group after their data safety and monitoring board found a significant difference in perinatal death between the groups.

Data safety and monitoring boards are basically a board that keeps track of what’s going on in the study. They get interim reports. And if they see any concerning safety issues, they have the power to stop the studies. That’s a standard part of a lot of randomized controlled trials is to have one of these safety boards.

Similar to the INDEX trial in the Netherlands, in Sweden, labor is typically not induced before 42 weeks if you have an uncomplicated pregnancy. Also similar to the Netherlands, in Sweden, midwives manage most of the pregnancies and births. It’s a midwifery-led model of care.

The purpose of the SWEPIS study was to compare elective induction at 41 weeks and zero to two days versus expectant management and induction at 42 weeks and zero to one day if the mother hadn’t gone into labor by that point. The study was carried out in the years 2015 to 2018. The researchers enrolled healthy mothers with single babies in head-first position. They had accurate gestational ages. They excluded people with a prior cesarean, diabetes, and other complications such as high blood pressure, small for gestational age, or known fetal malformations.

There is a pretty low stillbirth rate in Sweden, so they thought they would need about 10,000 people to see a difference between groups, but they ended up not needing nearly that many people to find a difference in stillbirth rates. One of the big strengths of the SWEPIS trial is that in contrast to the INDEX trial, in the SWEPIS trial they defined an induction protocol and they used that same protocol with everyone in the elective induction group and everyone in the expected management group who had an induction. The protocol was basically if the mother’s cervix was already ripe, they simply broke her water and gave her oxytocin as needed by IV. If the mother’s cervix was not ripe or the baby’s head was not engaged, they used mechanical methods or Misoprostol, or prostaglandins, or oxytocin, but they did cervical ripening first.

In the elective induction group, most of the people were induced. 86% had their labor induced. 14% went into labor spontaneously before the induction. In the expectant management group, 67% of them went into labor spontaneously and 33% ended up with an induction. Similar to the INDEX trial, there was a really tiny difference in the length of pregnancy between groups. Pregnancy in the elective induction group was in general only three days shorter than pregnancy in the expectant management group, but yet they did go on to find significant differences.

So what the SWEPIS trial found was that for babies – this is why this study was stopped early – there were five stillbirths and one early newborn deaths in the expectant management group out of 1,379 participants for a death rate of 4.4 deaths per 1,000 women. There were zero deaths in the elective induction group out of 1,381 participants. All five stillbirths in the expectant management group happened between 41 weeks, two days and 41 weeks, six days. Three of the stillbirths had no known explanation. One was for a baby that was small for gestational age. The other was with a baby who had a heart defect. There was one newborn death that occurred four days after birth due to multiple organ failure in a baby that was large for gestational age.

The authors mentioned that when complications are present at the end of pregnancy, such as problems of the placenta, or the umbilical cord, or fetal growth, these problems may become increasingly important as each day of pregnancy progresses, which they believe is why they found a higher death rate with expectant management past 41 weeks.

Another key finding of the study was that all of these deaths occurred to first-time mothers, which suggests that 41-week induction may be especially beneficial for babies of first-time mothers. They found that it only took 230 inductions at 41 weeks to prevent one death for a baby, and this was a much lower number than previously thought. If you remember, though, as Anna was saying, the INDEX trial did not find a significant difference in death between the induction group and the expectant management group. We think the reason the SWEPIS study found a difference was because it was a larger study, it was better able to detect differences in rare outcomes like death. Also, with the SWEPIS study, there might not have been as good fetal monitoring. So it’s possible that the better fetal monitoring of participants between 41 weeks and 42 weeks in the INDEX trial might’ve been protective, leading to fewer perinatal deaths. We can’t be certain though because there were no fetal monitoring protocols in either trial.

Another thing to note is that participants in the SWEPIS expectant management group tended to give a birth a little later than the participants in the INDEX expectant management group. That might help explain the higher perinatal death rate in the expectant management group in SWEPIS. They did not find a difference in what they call the composite adverse perinatal outcome, which included death, low Apgar scores, low pH, brain bleeds, brain injury, seizures, and several other major complications, but there was that significant difference in perinatal death (either having a stillbirth or newborn death).

Also, the elective induction babies were less likely to have an admission to intensive care, 4% versus 5.9%. They had fewer cases of jaundice, 1.2% versus 2.3%, and fewer of them were big babies, 4.9% versus 8.3%.

For mothers, the outcomes were overall pretty good. There were no differences in cesarean rates similar to the other trial. The cesarean rate in this study in both groups was about 10% to 11%. More mothers in the elective induction group had an inflammation of the inner lining of the uterus called endometritis, 1.3% versus 0.4%. And on the other hand, more mothers in the expected management group developed high blood pressure, 3% versus 1.4%. They also interviewed the women in both groups and they found that the mothers in the expectant management group really struggled with negative thoughts. They described feeling in limbo while they waited to go into labor. So Anna, can you talk a little bit about the fetal monitoring in this study and how it may have differed from the other study?

Anna Bertone:   Sure. Fetal monitoring in this study was done per local guidelines. So there was no study protocol for fetal monitoring during the 41st week of pregnancy. However, the mothers recruited from one region of Sweden, called the Stockholm region, which made up about half the people in the study, had ultrasound measurements of their amniotic fluid volume and abdominal diameter at 41 weeks, whereas the people that came from the other areas of Sweden in the study did not receive these assessments regularly. None of the six deaths that occurred in this study occurred in the Stockholm region of Sweden where they received this type of fetal monitoring, which leaves us with the question of how important was this fetal monitoring. Could it have made the difference between the Stockholm region participants not experiencing fetal deaths whereas participants from other regions did?

Anna Bertone:   So that’s just an important thing to keep in mind with this study is that the fetal monitoring may have made a difference as far as the perinatal outcomes. It also means that the results of the SWEPIS study might not apply equally to mothers who receive fetal monitoring at the end of pregnancy, specifically during that 41st week of pregnancy which seems to be the really critical time period. Another thing, all of the perinatal deaths in this study occurred to first-time mothers, which tells us that the results might not apply equally to mothers who have already given birth before.

…So in the SWEPIS study, out of the mothers in the study who had already given birth before and were having a subsequent baby, none of them experienced this stillbirth or newborn death, correct?

Anna Bertone:   Correct. Yes.

Okay. So all of the perinatal deaths occurred to first-time mothers.

Anna Bertone:   And the first-time mothers, by the way, they only made up about half of the participants in the sample, so it was about a 50/50 split.

So all of the fetal and newborn deaths from this study came from first-time mothers who lived in the areas of Sweden that did not do any prescribed fetal monitoring during that 41st week of pregnancy.

Anna Bertone:   That’s my understanding. Correct.

Okay. So those are the two big randomized trials that came out in 2019. Before they were published, there was a 2018 Cochrane meta-analysis. Anna, I was wondering if you could talk a little bit about that. This study did not include the SWEPIS and the INDEX trials, but we still wanted to talk about it in our article. So can you explain to our listeners a little bit about this Cochrane review?

Anna Bertone:   Sure. There was a 2018 Cochrane review and meta-analysis by Middleton. Unlike these randomized control trials that we were just talking about, they didn’t focus specifically on the 41st week of pregnancy versus the 42nd week of pregnancy. It was much more broad than that. What they did was they looked at people who were electively induced at some point, and compared them to people who waited for labor to start on its own until some point. So there was a much more broad range of gestational ages there. But they included 30 randomized control trials with over 12,000 mothers, and they compared a policy of induction at or beyond term versus expectant management. All of the trials took place in Norway, China, Thailand, the U.S., Austria, Turkey, Canada, the UK, India, Tunisia, Finland, Spain, Sweden, and the Netherlands.

So it’s quite a global sample.

Anna Bertone:   Yes. But one study in this meta-analysis really dominated and accounted for about 75% of the data, and that was the Hannah post-term trial that I think Rebecca is going to be talking about soon. Because that one trial dominated this meta-analysis so much, most of the data was on giving birth at 41 weeks or later.

And they did not include the ARRIVE trial in this meta-analysis.

Anna Bertone:   Right. They didn’t include the ARRIVE, INDEX, or SWEPIS trials. So in its next update, it’s going to be updated with those three randomized control trials. But they did include 30 other randomized control trials. What they found was that a policy of induction at term or beyond term was linked to 67% fewer perinatal deaths compared to expectant management. So that was two deaths with induction at or beyond term versus 16 deaths in the people assigned to expected management.

Anna Bertone:   The Hannah post-term trial excluded deaths due to fetal malformations, but some of the smaller trials that were included in the Cochrane meta-analysis did not. So if we exclude the three deaths from severe fetal malformations, then the final count is one death in the induction group and 14 in the expectant management group. So it doesn’t change the results too much overall to exclude fetal malformations. Overall, they found that the number needed to treat was 426 people with induction at or beyond term to prevent one perinatal death. Specifically, there were fewer stillbirths with a policy of induction at or beyond term.

Which was a different number needed to treat than the SWEPIS trial, which found only took 230 inductions at 41 weeks to prevent one perinatal death.

Anna Bertone:   Yeah. I think part of the reason the SWEPIS trial was so groundbreaking and got so much media attention is because it did find a lower number needed to treat than had been found previously. So the absolute risk of perinatal death was 3.2 per 1,000 births with the policy of expected management versus 0.4 deaths per 1,000 births with the policy of induction at or beyond term. They found that a policy of induction was linked to slightly fewer cesareans compared to expectant management, 16.3% versus 18.4%.

Anna Bertone:   Fewer babies assigned to induction had Apgar scores less than seven at five minutes compared to those assigned to expectant management. They didn’t find any differences between the groups with the rate of forceps or vacuum assistance at birth, perinatal trauma, excessive bleeding after birth, total length of hospital stay for the mother, newborn intensive care admissions, or newborn trauma. The authors concluded that individualized counseling might help pregnant people choose between elective induction at or beyond term or continuing to wait for labor. They stress that providers should honor the values and preferences of the mothers.

We need more research to know who would or would not benefit from elective induction. And the optimal time for induction is still not clear from the research, which is what they said in 2018. I think Rebecca’s going to talk about the famous Hannah post-term study that accounted for 75% of the data in that meta-analysis.

Yeah, so we’re kind of working backwards through time. We started with the 2019 randomized trials, then the 2018 meta-analysis where they said the optimal time for induction is not clear, but they stated that before the two new randomized trials came out. Then even before then going back in time is the 1992 Hannah post-term study, which is one of the most important studies on inducing for going past your due date and it was the largest randomized trial ever done on this topic, larger even than INDEX or SWEPIS. And it controls most of the findings in that Cochrane meta-analysis that Anna just described.

So let’s look at what happened in this study because it plays so much of a role in the meta-analysis. It was carried out between the years 1985 and 1990 when a group of researchers enrolled 3,407 low-risk pregnant people from six different hospitals in Canada into the study. Women could be included if they were pregnant with a live single fetus, and they were excluded if they were already dilating, if they had a prior cesarean, pre-labor rupture membranes, or a medical reason for induction.

This study had a much different expectant management protocol than INDEX or SWEPIS because unlike those studies where the longest you would go was 42 weeks and zero to one or two days, in the Hannah post-term study, the people assigned expectant management were monitored for as long as 44 weeks pregnancy before they were induced, so up to a month past your due date, which is almost unheard of today. At around 41 weeks, people who agreed to be in the study were either randomly assigned to have an induction of labor or fetal monitoring with expectant management.

In the induction group, labor was induced within four days of entering the study, usually about 41 weeks and four days. If the cervix was not ripe and if the fetal heart rate was normal, they were given a prostaglandin E2 gel to ripen the cervix. They used a maximum of three doses of gel every six hours. If this did not induce labor or if they did not need the gel, people were given IV oxytocin, had their waters broken, or both. And they could not receive oxytocin until at least 12 hours after the last prostaglandin dose.

So one strength of this study is that it had a defined induction protocol that providers could replicate. But the big weakness of this study is that the expectant management group did not have that same induction protocol. In the monitored or expected management group, people were taught how to do kick counts every day and they had a non-stress tests three times per week. They also had their amniotic fluid levels checked by ultrasound two to three times per week. And labor was induced if there were concerning results in the non-stress test, or if there was low amniotic fluid, or if the mother developed complications, or if the person did not go into labor on their own by 44 weeks. And if doctors decided the baby needed to be born, mothers in expectant management group did not receive any cervical ripening. Instead, they either had their water broken and/or IV oxytocin, or they just went straight to a cesarean without labor. So Anna, do you want to talk a little bit about what the researchers found in the study?

Anna Bertone:   What the researchers found in the Hannah post-term study is that in the induction group, 66% of the people were induced and 34% went into labor on their own before induction. And in the expectant management group, 33% were induced and 67% went into labor on their own. There were two stillbirths in the group assigned to wait for labor and zero in the group assigned to induction. This difference was not considered to be statistically significant, which means we don’t know if it happened by chance or if it was a true difference between the groups. The more interesting outcome to look at with the Hannah post-term trial are the findings on cesarean rates because they differ depending on what numbers you look at. You can either look at the outcomes for the two original groups, which were the people randomly assigned to induction and then those assigned to expectant management, or you can look at the breakdown of what actually happened to the people in the two groups, in other words what happened to the people who were actually induced or who actually went into spontaneous labor.

Anna Bertone:   So what happened in the original randomly assigned groups? If you look at the two original groups, the overall cesarean rate was lower in the induction group. It was 21.2% versus 24.5%. That was even after taking into account factors like the mother’s age, whether or not it was her first baby, and cervical dilation at the time of study entry. Or you could look at what happened with the people who were actually induced or who actually went into labor on their own. And if you look at that, you see two very interesting things. You see that people who went into spontaneous labor, regardless of which group they were assigned to, they had a cesarean rate of only 25.7%. But if people in the monitoring group had an induction, their cesarean rate was much higher than all the other groups. It was 42%. The same was true for both first-time mothers and for mothers who had given birth before.

Anna Bertone:   So what does this mean? It means that only the people who were expectantly managed but then had an induction had a really high cesarean rate. The people who were expectantly managed and then went into labor spontaneously did not have a higher cesarean rate. One possible reason for this, for the highest cesarean rate seen in the people who were assigned to expectant management but then ended up getting an induction, is that the people in this group might’ve been higher risk to begin with since a medical complication could have led to their induction. The people that were assigned to expectant management and never developed a complication requiring an induction, those were the lower risk people, which means they were the ones less likely to end up giving birth by cesarean.

Anna Bertone:   Then, another important factor that I know Rebecca has discussed previously is that doctors might’ve been quicker to call for a cesarean when assisting the labors of people with medical inductions if their pregnancies were beyond 42 weeks. They may have been less patient waiting for labor.

…Or more easily worried about the course of the labor, big baby, etc. – 

Anna Bertone:   Yes. More worried.

So basically, it seems like from the Hannah post-term trial, one of the benefits of considering expectant management is that if you do have spontaneous labor, your chance of cesarean is pretty low. But the risk is that you’ll develop medical complications and need an induction, in which case an induction at 42 weeks is going to be riskier than an induction at 41 weeks. So what do you think? We have all this research from all over the world, from the Hannah post-term trial, to the 2018 meta-analysis, to two trials out in 2019. Do you still feel like routine induction at 41 weeks is still going to be controversial or not?

Anna Bertone:   I think it’s definitely still controversial, and I think everybody’s still processing the results from the INDEX trial and the SWEPIS trial. Rebecca and I reached out to Dr. Wennerholm who conducted the SWEPIS trial in Sweden, and she said she’s currently working on secondary analysis of the data. They’re talking about the economic implications of the findings in Sweden and what it means for Swedish national policy. So I think it’s still controversial. People are still talking about what to make of these findings.

Anna Bertone:   There was another systematic review from 2019 by Riedel. This one came out too early to include the SWEPIS and the INDEX trials, but it’s still interesting to look at. Because unlike the Middleton Cochrane review, these authors were specifically interested in induction during the 41st week of pregnancy versus during the 42nd week of pregnancy. So in their analysis, they restricted the studies only to people having a routine induction at 41 weeks and zero to six days versus routine induction at 42 weeks and zero to six days. If you remember, the Cochrane review was much broader than that. They also only looked at studies published within the last 20 years. They only looked at studies with low-risk participants, and they ended up with three observational studies, two randomized controlled trials, and two studies that they called “quasi experimental studies”, which they grouped with the randomized controlled trials even though these studies weren’t truly randomized.

Anna Bertone:   What they found was one perinatal death in the 41 week induction group and six deaths in the 42 week induction group. That was a rate of 0.4 versus 2.4 per 1,000. This finding was not statistically significant. In other words, we don’t have strong enough evidence that this couldn’t have happened by chance. These same studies, those two randomized controlled trials and the two quasi experimental studies, they showed no difference in cesarean rates between groups also. But the authors did report that one observational study found an increase in the cesarean rate with the 41 week induction group. So basically, they’re saying if you look much more narrowly at the evidence of induction during the 41st week versus the 42nd week, then there might not be a significant difference in the death rate.

But that Riedel study from 2019 is already outdated because that was before the two big randomized trials came out.

Anna Bertone:   Yes. We need to see a systematic review and meta-analysis that includes those two randomized controlled trials and see if that changes. These authors also expressed concerns about the cesarean rate possibly rising with 41-week induction because both the SWEPIS trial and the INDEX trial took place in countries with very low cesarean rates. So we just don’t really know at this point whether there would be a difference in cesarean rates if they took place in countries with higher rates of cesarean, such as the U.S.

Anna Bertone:   So I think it is still controversial. There’s also countries that are changing their policies about induction and going back and looking at whether that policy change led to any difference in outcomes. One such country is Denmark. They just published a study where they compared birth outcomes from 2000 to 2010 versus 2012 to 2016. And in that time period there was a change in policy from recommending induction at 42 weeks and zero days to 41 weeks and three to five days. They included over 150,000 births in the dataset. And when they looked back, they didn’t see any difference in stillbirths, or perinatal deaths, or low Apgar scores when they compared the period before versus after the policy change. The perinatal death rate was already declining before the policy change in 2011, and it just continued going down without any additional impact from the 2011 policy change. There was also no impact on the rate of Cesareans with the policy to switch from 42 weeks to 41 weeks.

Anna Bertone:   That’s just an example of how this is still controversial. Countries are implementing new policies, and Sweden and the Netherlands may implement new policies based on the INDEX and the SWEPIS studies. Then they’ll probably conduct a study the same way that Denmark did to see if that policy change had any real impact on the population.

I think it’s important to mention, though, that with the Denmark national policy, they switched from 42 weeks and zero days to 41 weeks and three to five days, and that might not have been early enough to make an impact on the stillbirth rate because the studies that we were looking at from 2019, SWEPIS and INDEX, were looking at inductions happening at 41 weeks and zero to one or two days and it was that couple of days difference that made the difference between low stillbirth rate and a higher stillbirth rate.

Anna Bertone:   Right. Exactly. I think that future researchers shouldn’t group 41 weeks and zero to six days together in one grouping because there seems to be differences between the earlier part of the 41st week and the later part of the 41st week because, like you said, SWEPIS and INDEX found that waiting even just two or three days make a difference in outcomes during that week.

So let’s just sum up the pros and cons of induction at 41 weeks versus continuing to wait for labor since that’s what we have the bulk of the evidence on now. I would say that the research shows that the pros of inducing labor at 41 weeks include a lower risk of stillbirth, especially among those with risk factors for stillbirths such as being pregnant with your first baby. In our article, we have a table of the pros and cons. The absolute risk of stillbirth is 4 out of 10,000 pregnancies at 39 weeks, 7 out of 10,000 pregnancies at 40 weeks, 17 out of 10,000 pregnancies at 41 weeks, and 32 stillbirths out of 10,000 pregnancies at 42 weeks. Research also shows a lower risk of the baby receiving intensive care with an elective induction at 41 weeks, lower risk of the baby having jaundice, lower risk of the baby being large for gestational age, and lower risk of needing a cesarean, although that finding may depend on your practice setting. There is a lower risk of mother developing a high blood pressure disorder. at the end of pregnancy. And for some people, they may find an elective induction at 41 weeks convenient and it could help them end an uncomfortable pregnancy.

Also, in our article, we reference one study that found some cognitive benefits for babies. It suggests that the cognitive benefits for the baby from the mom remaining pregnant appear to increase until about 40 to 41 weeks after which there’s no cognitive benefits to the baby’s brain development for continuing to remain pregnant. So Anna, can you share the cons of elective induction at 41 weeks?

Anna Bertone:   Yeah. One of the cons of being induced at 41 weeks instead of continuing to wait and see if you go into labor is the potential for medicalization of birth. One example of this is continuous fetal monitoring may occur if you have the induction, whereas you might not get continuous fetal monitoring if you go into labor on your own spontaneously during that 41st week. 

Anna Bertone:   Another con would be a potential for failed induction leading to a cesarean. That also depends a lot on your practice setting. Another con is the potential for uterine tachysystole, which is defined as more than five contractions in 10 minutes averaged over 30-minute window. There’s a potential increase in the risk of uterine rupture with medical induction. That is especially important among people with a previous cesarean having a VBAC.

Anna Bertone:   Another con is missing the hormonal benefits of spontaneous labor. Another con is increased risk of mother getting inflammation of the inner lining of the uterus, endometritis. One study found that as a possible risk of induction 41 weeks. Then, lastly, medically-induced contractions might increase pain and make epidural use more likely.

We also have a section in the article where we talk about whether there are any benefits to going past your due date. That table we just took you through was comparing the benefits and risks of elective induction. In terms of benefits of going past your due date, one of the major benefits of awaiting for spontaneous labor are the hormonal benefits, which Anna briefly mentioned. In our article, we link to the book Hormonal Physiology of Childbearing by Dr. Sarah Buckley, which talks about the physiologic understandings and the physiology of spontaneous labor. So that is something to keep in mind, and that’s one reason why some people prefer to wait for spontaneous labor. So Anna, if someone wants to wait for labor to begin on its own and they’re talking with their care provider about expectant management, what’s kind of the bottom line about that?

Anna Bertone:   I think the bottom line about that is it all needs to be very individualized. When someone goes past their estimated due date, they could talk to their care provider about the benefits and the risks of elective induction versus continuing to wait for labor and how those benefits and risks apply to them personally. Most research articles and guidelines say that because there are benefits and risks to both options, the pregnant person’s values, goals, and preferences should play a part in the decision-making process.

Anna Bertone:   It’s important for expectant families to be aware of the growing research evidence showing that there could be worse health outcomes for those who wait for labor after 41 weeks of pregnancy instead of being induced at 41 weeks, especially among first-time mothers and those with additional risk factors for stillbirth. But ultimately, after receiving accurate evidence-based information and having conversations with their care providers, pregnant people have the right to decide whether they prefer to induce labor or wait for spontaneous labor with appropriate fetal monitoring.

I want to also let people know about a couple more resources that are in this article at evidencebasedbirth.com/inducingduedates. We have a section all about how people and their care providers can talk about the risk of stillbirth with some sample scripts that healthcare providers can use when they’re talking about risks of stillbirth. We also have links to different guidelines from different organizations about induction at 41 weeks. Then we also have our section called The Bottom Line. So what would you say are some of the bottom lines, Anna, about elective induction at 41 weeks and zero to two days?

Anna Bertone:   I think the bottom line is that elective induction at 41 weeks and zero to two days could help to reduce stillbirths and poor health outcomes for babies without increasing harm, like the risk of Cesarean for mothers. We’re getting that from those two large randomized controlled trials published in 2019 that both found benefits to elective induction at 41 weeks instead of continuing to wait for labor until 42 weeks. One of those studies, as we mentioned, found less perinatal death with 41 week induction and the other found fewer poor health outcomes for babies like intensive care unit admission and low Apgar scores with 41 week induction. Neither of those trials found an increase in the risk of Cesarean during birth with 41 induction compared to continuing to wait for labor until 42 weeks. However, both of those trials took place in countries that follow the midwifery model of care and the overall Cesarean rates were very low. So I think it remains to be seen how that will translate into countries like the U.S. that have higher Cesarean rates. 

So I hope you all found this podcast helpful in looking at the recent research on induction at 41 weeks versus expectant management. Make sure you check out the blog article that goes along with this podcast episode for all of the resources, links, research references. We also have a free one-page handout you can download that summarizes the results of this research. Just go to evidencebasedbirth.com/inducingduedates to download that new article. Thank you so much, Anna, for joining us to help our listeners understand the evidence.

Anna Bertone:   Happy to do it, Rebecca. Thank you.

Today’s podcast was brought to you by the PDF library inside the Evidence Based Birth Professional Membership. The free articles that we provide to the public at evidencebasedbirth.com and this free podcast as well as other resources are supported by our Professional Membership program. Everyone who joins our professional membership gets access to a library with all our printer-friendly PDFs. Each signature article that we publish online has been turned into a professionally-designed, easy-to-print PDF so that our members can print and share evidence-based info with their clients, other parents, or other professionals. To learn how you can become a member today, visit ebbirth.com/membership.

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Russia’s Putin Wants Traditional Marriage And God In Constitution | News | Peacefmonline.com

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Russian President Vladimir Putin wants marriage to be defined as the union of a man and woman in a revised constitution, ruling out gay marriage.

It is among several constitutional amendments proposed by Mr Putin, which are set to be put to a public vote.

Critics see the proposals as a move by Mr Putin to keep a hold on power after his presidential term ends in 2024.

The package includes a proclamation of Russians’ faith in God and a ban on giving away any Russian territory.

The territorial amendment would strengthen Russia’s hold on Crimea – a Ukrainian region it annexed in 2014 – and the Kuril Islands, disputed with Japan since World War Two, according to Vladimir Mashkov, a renowned actor-director involved in drafting the new constitution.

Mr Putin also proposed an amendment on “historical truth”, to protect “the great achievement of the people in their defence of the Fatherland”.

He has railed against what he sees as foreign attempts to diminish the enormous sacrifice made by the USSR in World War Two. The defeat of Nazi Germany cost an estimated 27 million Soviet lives.

Mr Putin is in his fourth presidential term; he has been the dominant figure in Russian politics for 20 years. His presidency has been marked by a revival of Soviet-era symbols, conservative values and the influence of the Russian Orthodox Church.

He surprised the nation in January with plans for constitutional changes that include transferring some powers from the presidency to parliament.

While most Russians identify as Orthodox Christians, the state is officially secular. The current constitution dates from 1993, when then President Boris Yeltsin was embracing Western democracy and capitalism.

Mr Putin’s drive against Western liberalism has included a controversial ban on disseminating “gay propaganda” among young Russians. The ban – condemned by many liberals and the European Court of Human Rights – has been used to harass gay rights activists.

The constitutional reform bill was approved by the Russian parliament’s lower house – the State Duma – in January, and Mr Putin’s amendments were introduced in time for a second reading next week. The Russian legislature is dominated by Putin supporters.

A public vote on the constitutional revision is scheduled for 22 April, but before then it has to get final approval from parliament and the Constitutional Court.

A Russian political analyst, Konstantin Kalachev, told BBC Russian that the proposals were “a mixed bag”. “It turns out that our forefathers gave us faith in God and the ideas of communism,” he commented, but added: “Putin is a mirror for the majority of Russians”.

Many of the amendments were submitted to Mr Putin by prominent social and cultural figures appointed to a constitutional working group.

Political scientist Grigory Golosov criticised the changes as “political”. “The constitution we have indicates that the state should be free of ideology. So I think these changes are inappropriate.”

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‘I have no intention to be rewarded’: Grab driver says after giving free ride to passenger whose father died, Singapore News – AsiaOne

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Most Grab drivers take us to our destinations. Some go the extra mile.

One Grab driver is being praised for making a difficult day just a little better for one rider when he waived the fare and even gave her an ang bao after learning that her father had just died.

Nasran Zainal’s good deeds first came to light when the passenger, who remains unnamed, took to Facebook to share their encounter on Feb 28.

She had booked a ride on Feb 26 heading to Singapore General Hospital to visit her father, who had died earlier that day.

“I booked a Grab ride from home to SGH and got a driver who was travelling along PIE (Pan Island Expressway) and three minutes away. I was with my aged mum,” she wrote.

“After a while, I checked the app and suddenly saw that he was along ECP (East Coast Parkway) and the waiting time turned to 11 mins.”

Feeling confused, she messaged Nasran to clarify and explained their reason for heading to the hospital.

Nasran, 34, sent his condolences and explained that he had to make a detour as he had been at an exit along the expressway when he received the booking, but assured them that he would pick them up nonetheless.

At this point, she was “already very appreciative” of Nasran, she said.

But there were more surprises to come.

When they reached the hospital, Nasran handed them an ang bao, saying it was a “small token”.

“I rejected it and said ‘don’t need’ as I felt really paiseh (embarrassed) of him doing that [sic]. After some haggling, I accepted the small token as he was really insistent.”

The second surprise came the next day when she received a refund of the $11 fare.

After enquiring with Grab’s customer service personnel, she found out that the driver had requested the refund as a “goodwill token”.

Addressing Nasran, the passenger wrote: “You are really a shiny gem who went the extra mile. Anyone who knows Mr Zainal, please pass the message to him. Thank you.”

The post quickly attracted over 6,400 shares and some 800 comments singing Nasran’s praises.

One commenter wrote: “We salute you Mr Zainal. You are a very kind and compassionate man. May God bless you and your family.”

Another said: “A great man with a wonderful heart. May you be blessed with good health and happiness. Drive safely and thank you for your kindness.”

Speaking to AsiaOne on Mar 2, Nasran explained:

“Upon hearing that her dad passed away, I really felt sad for the family. In my heart, I said I should do something for the family.

“I have always believed we should do something for the community and help anyone whenever they need, regardless of race or religion.”

In response to his good deed going viral, Nasran was modest and self-effacing, saying that there were others who had “done much more” than him.

“Honestly I really didn’t expect this to be viral as I have no intention to be rewarded for what I have done. I feel blessed and thankful to all the people who have been sharing this news and sending good wishes for myself and my family on social media.”

AsiaOne has reached out to Grab for comment.

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Church and State in Montenegro: between National(istic) and Imperial Policies | Political Theology Network

A crisis is brewing in the tiny ex-Yugoslav country of Montenegro. There are massive street protests, attacks on priests, and fights in the Parliament. Various domestic, regional, and international actors, interests and policies are at stake here, giving us the opportunity to learn important lessons about national (and nationalistic) ideological projects, and the role of religion and international (also imperial) aspirations in their creation. And yet, mainstream Western media has shown little interest in the matter. One can speculate why.

The Government of Montenegro proposed new legislation on religious organizations called “The Law on the Freedom of Religion,” which was approved by the Parliament on December 27, 2019.  A draft version of the document is available from the website of the Ministry for Human and Minority Rights, both in the local language and in English. The legislation generated significant controversy due to its treatment of religious organizations, their internal procedures, as well as their property.

Article 4 specifies that:

“Prior to the appointment, i.e. announcement of the appointment if the highest religious leaders, a religious community shall confidentially notify the Government of Montenegro (hereinafter: the Government) about that.”

Article 16, § 1 requires that the application for registration of a religious community shall contain:

“The name of the religious community, which must be different from names of other religious communities and must not contain the official name of other state and its features”

For many, the most problematic article is 52, found under the
section “Transitional and Final Provisions”:

“Religious facilities and land used by the religious communities in the territory of Montenegro and for which is found to have been built or obtained from public resources of the state or have been in state ownership until 1 December 1918, as the cultural heritage of Montenegro, shall be the property of the state. Religious facilities for which if found to have been built on the territory of Montenegro from joint investments of the citizens until 1 December 1918, shall be the property of the state.”

The law caused an outrage among the members of the Orthodox Church
in Montenegro. Let me sketch some of the background which will, hopefully,
render the current crisis more intelligible.

There are four Orthodox dioceses (belonging to the Serbian
Orthodox Church, i.e. Patriarchate of Peć) whose territory is fully or in part
located on the territory of Montenegro. The Orthodox Church (i.e. these four dioceses)
is, by far, the largest religious organization in the country.

The majority of both the clergy and laity view the new legislation as a purposeful targeting of the Church by the Government. They interpret Article 16, § 1 as specifically crafted against the Orthodox Church, as the above-mentioned dioceses in Montenegro belong to the Serbian Orthodox Church. However, the Article 52 appears to be a much more serious threat. Many these churches and monasteries are centuries old, predating even the formation of the modern state of Montenegro. If enacted, Article 52 could lead to the confiscation of Church property and its sacral objects.

Why would the government do this? Why would it go against the Church,
in a country where a significant majority of the population considers itself
Orthodox? This is where things get complicated.

Arguably the chief political authority in Montenegro, over the
past three decades, has been Milo Đukanović. He assumed the office of prime
minister in 1991, and has been in power ever since, performing the roles of
prime minister and president interchangeably (with a couple of years of break,
2006-2008, and 2010-2012). This style of rule brings to mind rulers in other
parts of Europe who have de facto been chief figures in the political
life of their countries for long periods of time, regardless of the name of the
office they would hold in a given moment. Not all long-lasting autocrats are
the same though: There are those who “we” (in the West) do not like very much,
since they refuse to obey us (branded as “evil autocrats”), and there are “our
kind of guys,” who are submissive enough to the Western political and economic
centers (branded as “democratic rulers”). Milo Đukanović, of course, belongs to
the latter group. During his pontificate the country joined the NATO alliance (in
2017), and he has successfully resisted a stronger Russian influence in the
country.

Đukanović, once upon a time, was loyal to Serbian president
Slobodan Milošević, and his allies in Montenegro. However, he switched sides just
in time, and his chief project became an independent Montenegro (proclaimed in
2006) and close cooperation with Western governments, military, and
multinational corporations. This where problems with the Serbian Orthodox
Church in Montenegro begin, in particular with the most prominent figure of
Montenegrin religious life—Metropolitan Amfilohije (Radović). At times partners,
at other times in conflict, this turbulent relationship between the politician
and the metropolitan has ended up, as of now, in an open battle.

Đukanović’s vision of independent Montenegro and the new
Montenegrin identity also includes the vision of an autocephalous (“self-governed”)
“Montenegrin church” which would be loyal (some would suggest obedient as a much better word choice) to the State (i.e., his regime). Amfilohije and
other bishops do not seem to share the same vision. For them, there is no conflict
between an “authentic” Montenegrin identity and Serbian identity, and therefore
no problem with the Orthodox Church in Montenegro being part of the Serbian
Orthodox Church. (Nota bene, many figures and structures within the Serbian
Orthodox Church are by no means innocent in the political games that have been
played in the region, particularly when it comes to Serbian nationalism and the
policies of various autocrats from Belgrade, but that is a topic for another analysis.)

To foster a new Montenegrin identity, Đukanović’s regime started
to promote “Montenegrin Orthodox Church” as an “autocephalous” organization,
headed by the colorful figure of Miraš Dedejić. According to some sources, Dedejić
used to be an admirer of Slobodan Milošević and his policies. He had also been a
priest of the Ecumenical Patriarchate until he was excommunicated by Patriarch
Bartholomew. This organization is not recognized by any of the canonical
Orthodox Churches. Even Đukanović’s support has not been full or unconditional.
One is tempted to say that its purpose has primarily been to put pressure on Amfilohije
to follow the “right path.”  

This is how one can understand the recent actions, at least in one
of their complex and intertwined dimensions: Just as the Ukrainian political
leadership was advancing the (formerly) uncanonical church structures and their
autocephaly in the hope that it would strengthen Ukrainian national identity, as
well as the political elite who championed the project, Montenegrin leadership
might hope that promoting one group, which would be loyal to one political
project and obedient to the political authorities (Amfilohije has not proven
himself in that role), would lead to the recognition of autocephaly of that
group, with same or similar political results. Probably working out of these
hopes, the regime has, then, threatened the confiscation of Church property of
the “disloyal” Church, which is quietly accepted (if not blessed) by the
Western political centers. The trade seems straight-forward, based on a
widely-practiced strategy: “We” (political/economic centers in the West) will
turn a blind eye to violence, undemocratic policies, the autocratic style of
rule, breach of various rights, and so forth, and “you” (local political
elites) will ensure that the (military, economic, political) interests of those
centers are protected and advanced locally.

An obstacle in the case of Montenegro (unlike in the case of
Ukraine) is the fact that the Ecumenical Patriarchate does not seem willing to intervene
to support the formation of a new autocephalous Church, which would advance the
local national identity, being closely connected to the State. Not yet at least,
and not with Miraš’s team as a new autocephalous
church. It seems that there is awareness that right now there are no credible
candidates in Montenegro who would be willing to lead a potential autocephalous
church, neither there is popular support for such project.

For those less familiar with Orthodox ecclesiology, it is worth noting that in Orthodoxy there is no equivalent role to the one of the Roman pontiff. Orthodox ecclesiology has advanced the principle of conciliarity instead of the (universal) primacy of power of one ecclesiastical/imperial center. This does not mean, of course, that there have been no attempts of ecclesiastical seats to assume such power. Indeed, just as the seat of Rome infused the universalist aspirations to power into the emptied shell of the Western (Roman) Empire, so the bishops of “New Rome” (Constantinople) have occasionally aspired to assume both universal ecclesial, and even political authority (at times when the Empire was weakened). This universalism is reflected also in the title of the bishop/patriarch of Constantinople – “Ecumenical” – as the authority of this episcopal seat, as well as the authority of the (Roman) emperor, should ideally stretch over the entire oikoumene (inhabited world). What one can see, based on the recent actions of the Ecumenical Patriarchate, is the (renewed) aspiration to usurp a position within the Orthodox world which would be, in some aspects at least, comparable to the position which the Roman pontiff gradually acquired in the West. This, predictably, provokes a lot of criticism.

The entire episode can thus be understood as yet another example of how the whole concept of autocephaly, the way it is generally understood and practiced in “Orthodox countries” nowadays, is highly problematic. If autocephaly is understood as something “naturally” linked to national/ethnic identities (and/or nation states), it is both theologically unacceptable and very harmful to the body of the Church in long term. Serious Orthodox ecclesiology does not operate with the concept of “national Churches,” although it has been widely (and mistakenly) used both in the public discourse and, sometimes, in academia. Local Churches (i.e. dioceses) are organized as administrative regional ecclesiastical unites, that gather the faithful of a certain territory (for the sake of serving the Liturgy) regardless of their ethnicity, nationality, gender, class, race, etc. The predominant culture or customs have always been embraced in the Orthodox tradition, leaving a trace on how the service is conducted, which language is spoken, etc. However, the identity of the Church is not derived from the ethnic, national or other identities of the majority population of a certain territory, but from the Eucharist as the icon of the Kingdom of God. This is why an autocephalous Church makes sense as a self-governing administrative organization of dioceses of a certain region, having one of the local bishops as their own “head” (having the title of metropolitan, archbishop, pope or patriarch), but not as a “national” institution, or a Church of certain ethnic group (which, following Orthodox ecclesiology, amounts to nothing less than a heresy).

In practice, however, just as local ecclesiastical and political
elites are eager to exploit the (seriously flawed) understanding of autocephaly
as “national institutions,” for the sake of their own power struggles, so is
the Ecumenical Patriarchate. (Neo)imperial policies of ecclesiastical centers
(in this case of Phanar) can thus be very similar to the (neo)imperial policies
of States; both try to manipulate local nationalisms to their own advantage.
Therefore, if they serve the (neo)imperial agendas of “New Rome,” local
nationalisms and local “national” churches will be blessed. If they don’t,
local nationalisms and their cravings for autocephaly will be condemned in the
name of (neo)imperial “universalisms.”

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‘Your seat just ruined my livelihood’: Passenger furious after reclined seat destroys laptop | Stuff.co.nz

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A passenger aboard a Delta Airlines plane has slammed flyers who recline their seats after his laptop was destroyed by the person in the seat in front of him.

Pat Cassidy, an anchor on Barstool Sports’ ‘Hard Factor News’ podcast, was flying in the US when the incident occurred and took to Twitter from the air to voice his fury.

“@Delta small note for the suggestion box, maybe have a little warning sign or someway to prevent my laptop from being destroyed when the person in front of me reclines their seat,” Cassidy tweeted.

PAT CASSIDY/TWITTER
Pat Cassidy said the passenger in front of him had ‘castrated [his] livelihood’.

“Also, this one is more of a critique than a suggestion. I really appreciate that your flight attendant came over to tell me that the passenger in front of me ‘needs to be able to recline’ and then asked him ‘if he was okay?’ as if your seat hadn’t just ruined my livelihood.”

Infuriated by the incident, Cassidy took to the Barstool Sports website with a piece about his experience, where he referred to the person in the seat in front of him as “the selfish b—tard” who had “castrated [his] livelihood”.

@Delta small note for the suggestion box, maybe have a little warning sign or someway to prevent my laptop from being destroyed when the person in front of me reclines their seat. pic.twitter.com/QHmphXiDhH

— Pat Cassidy (@HardFactorPat)

In the article he explains that he was editing photos on his laptop when the person in seat 13A reclined his seat completely, “destroying” Cassidy’s laptop in the process.

“YOU NEVER FULLY RECLINE. It’s rude and a sign of sociopathy,” Cassidy wrote.

“People that fully recline have no souls.”

The incident reignited the ongoing debate over whether it’s socially acceptable to recline your seat on a plane, with people for and against reclining sharing their views.

Update: @Delta is giving me the equivalent of a $75 gift card and an explanation that you would give a six year old. Cool. pic.twitter.com/etGLUXOOjs

— Pat Cassidy (@HardFactorPat)

Some insisted that Cassidy’s laptop was proof that seats should never be reclined on planes, or at least not fully reclined, while others said that the person in front should have reclined more gently.

However, fellow Twitter users pointed out that it wasn’t entirely 13A’s fault that the laptop had been damaged.

“Am I the only one to think this is not the airline’s fault? You tucked the screen into the tray storage area. Frankly, it’s unsurprising that this would happen,” one replied to Cassidy’s original tweets.

Another chimed in: “Pretty easy to tell if you jam your computer under there that will happen.”

Am I the only one to think this is not the airline’s fault? You _tucked_ the screen into the tray storage area. Frankly, it’s unsurprising that this would happen.

— Hisham (@hisham_hm)

On Saturday, Cassidy updated his Twitter thread with Delta’s response to the incident, saying that the airline had offered him “the equivalent of a $75 gift card and an explanation you would give a six-year-old.”

Attached to the tweet was a screenshot of an email that looks to have come from the Delta customer care team, which explains that personal items damaged in-flight by other passengers aren’t reimbursable.

Instead Cassidy was offered 7,500 bonus miles “as a goodwill gesture” and the airline apologised for any “inconvenience”.

Delta later reached out to Pat, responding to his tweet with: “Afternoon, Pat. I would like to review this further with you. May I give you a call? HDR.”

This article first appeared on Nine Honey and is republished with permission. 

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Mums have their say on the best hospitals to give birth at in the North East – see how yours fared – Chronicle Live

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Two North East hospitals have been voted among the best places in England to give birth as the region once again outperformed the rest of the country in a survey of new mothers.

The annual maternity services poll – which asked 17,151 women about their experiences of pregnancy and birth – found an improvement in the standard of care offered to new mothers on NHS wards nationally.

The poll, from the Care Quality Commission (CQC), showed many women saying positive things about their care during pregnancy and birth, but a poorer experience of care postnatally.

Results published on Tuesday, January 28, showed that a fifth of new mothers were not told how to access help if their mental health were to decline after giving birth and more than one in 10 (12%) were not warned about any changes they might experience to their mental health after having their baby.

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Sunderland Royal Hospital was the best performing nationally with the most positive responses to the survey (88%) when compared to all other trusts and a national average of 78%.

And the Newcastle upon Tyne upon Tyne Hospitals NHS Trust, which runs the Royal Victoria Infirmary, was the only trust to be rated ‘better than expected’ in all three main categories – labour and birth, staff during labour and birth, and care in hospital after the birth.

Gateshead, Northumbria Healthcare (which covers Northumberland and North Tyneside) and County Durham and Darlington trusts scored ‘about the same’ as other trusts overall.

There was no data available for South Tyneside due to the size of the maternity unit.

The poll was among women who gave birth in February 2019.

Sunderland Royal Hospital

High-scoring categories for City Hospitals Sunderland included 9.8/10 of women saying they were treated with respect and dignity during labour and birth and 9.8/10 who said they were spoken to during labour in a way they could understand.

Newcastle’s highest scoring categories for the Royal Victoria Infirmary were also ‘respect and dignity’ (9.8/10) and partners being involved as much as they wanted (9.8/10).

The Northumbria Healthcare NHS Foundation Trust, which runs the Northumbria Specialist Emergency Care Hospital in Cramlington, scored 9.7/10 for partners being as involved as they wanted and for clear communication.

QE Gateshead scored 9.9/10 for partner involvement and 9.3/10 for both skin to skin contact after birth, and the cleanliness of the ward.

County Durham and Darlington were rated ‘better’ than other trusts in the country for confidence and trust in staff (9.5/10) and receiving the information and explanations they needed after the birth (8.6/10).

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Stella Wilson, directorate manager for women’s services, at Newcastle Hospitals, said: “We’re delighted to see such wonderful feedback from the National Maternity Survey.

“Patient feedback is one of the best ways for us to measure the quality of our maternity services and in addition to these fantastic results and through our Maternity Voices Partnership, we actively seek the views of all women across Newcastle who have been in our care.”

Sheila Ford, head of midwifery at South Tyneside and Sunderland NHS Foundation Trust, said: “To be rated nationally as the best performing Trust in the whole country is absolutely fantastic news for the team and shows that local mams are receiving the very best maternity care right here in Sunderland.

“This is testament to the hard work of our maternity team and shows the level of care, dedication and compassion that our staff show to all of the families who choose to deliver with us and I am extremely proud to be part of such a wonderful team.

“There are, of course, areas where we must improve further and we will be looking at the results in detail, alongside other sources of feedback to the Trust, to make sure we continue to listen, learn and continue to develop the very best maternity services for local women in our area.”

Lesley Heelbeck head of midwifery at Gateshead Health said: “In Gateshead we have a really enthusiastic and committed team so it’s good to see such positive ratings from the CQC. Mothers and families are central to developing the services here at Gateshead so we’re always looking at ways we can improve.

“We’ve developed our maternity voices partnerships so that we can talk to local people and listen to their views more closely. Because we’re a smaller unit we aim to provide much more personal and individual care to everyone who comes here to give birth.

“We want as many local people as possible to come here and start their family with us and we aim to improve even further in the future.”

A spokesperson for County Durham and Darlington NHS Foundation Trust, said: “Pregnancy, labour and childbirth are one of the most important experiences women have and we’re delighted to have received this excellent feedback from women in the care of our maternity services.

Northumbria Specialist Emergency Care Hospital, in Cramlington, Northumberland

“In particular, we’re proud that in six categories our score was higher than for most trusts across the country.

“These include the number of women who said they had confidence and trust in those caring for them during labour and birth and the number of women who said their decisions about how they wanted to feed their baby were respected.

“We’re also delighted that we scored above the national average for the number of women reporting that a midwife or health visitor asked them about their mental health.”

Jenna Wall, head of midwifery at Northumbria Healthcare NHS Foundation Trust, said: “Providing our families with the best possible experience while having a baby with us is one of our top priorities and we welcome the feedback from the national maternity survey.

“We are pleased that during labour and birth women felt they were communicated with in a way they could understand, they were treated with respect and dignity and they had confidence and trust in the staff caring for them.

“It is also great that we have scored highly on facilitating skin to skin contact with the baby shortly after birth, involving partners and enabling them to stay as long as they want at our Northumbria hospital.

“These results are testament to our hard-working teams and I’d like to thank them for the dedication and compassion they show to women and their partners at this special time.

“We will, however, continually strive to do even better for our families and further improve the care during and after the birth of a baby.”

See how your trust scored here and how it compared nationally to other trusts:

City Hospitals Sunderland (South Tyneside & Sunderland)

Labour and birth – 9.2/10 – About the same

Staff – 9.3/10 – Better

Care in hospital after the birth – 9.0/10 – Better

County Durham and Darlington NHS Foundation Trust

Labour and birth – 8.9/10 – About the same

Staff – 8.8/10 – About the same

Care in hospital after the birth – 7.6/10 – About the same

Gateshead Health NHS Foundation Trust

Labour and birth – 8.8/10 – About the same

Staff – 8.6/10 – About the same

Care in hospital after the birth – 7.8/10 – About the same

Northumbria Healthcare NHS Foundation Trust

Labour and birth – 8.9/10 – About the same

Staff – 8.8/10 – About the same

Care in hospital after the birth – 7.8/10 – About the same

The Newcastle upon Tyne Hospitals NHS Foundation Trust

Labour and birth – 9.4/10 – Better

Staff – 9.3/10 – Better

Care in hospital after the birth – 8.5/10 – Better

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Andrea Hayden Twins’ strength and conditioning coach | Minnesota Twins

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FORT MYERS, Fla. — Andrea Hayden isn’t too accustomed to having Twins players upset with her. But she was thrilled about it.

Several players had seen Hayden featured in a television segment that highlighted her as the first female strength and conditioning coach in Major League Baseball, and they approached her in the weight room, aghast that they hadn’t already been aware of Hayden’s place in league history.

“How did we not know?” they asked her.

“I wear that as a badge because you’re not supposed to know,” Hayden said. “‘Good. I’m doing my job, because you shouldn’t be aware. You need to focus on what we’re doing and where we’re headed as an organization.'”

Hayden officially became a member of the Twins’ coaching staff last November, when strength and conditioning director Ian Kadish promoted her to assistant coach following a year-long fellowship during the 2019 season. Nobody was really aware of it at the time, but that made her not only the first female strength and conditioning coach in MLB history, but also the first full-time female member of a Major League staff.

It was only later on that Kadish and Hayden got curious and looked through the MLB staff directory to see if there was anyone else. There wasn’t. (Gabe Kapler and the San Francisco Giants have since hired Alyssa Nakken to their Major League staff.)

“OK, cool,” Hayden told Kadish. “Let’s move on. We have work to do.”

That workmanlike attitude defines how both Hayden and the Twins’ organization have approached this move. Kadish offered her the job because he saw her personality as a great fit on his staff and he felt a strong connection to her working philosophy. Kadish considers Hayden to be more of an expert than himself in Olympic lifts and has given her a lead role in the Twins’ performance-testing initiatives.

Hayden is here to contribute her knowledge to the championship push of a 101-win team, and that’s a responsibility she takes very seriously.

“She’s got a great personality, she’s got great knowledge in her field, and she’s adapted to the Major League clubhouse, it feels like effortlessly,” Twins manager Rocco Baldelli said. “It didn’t take very long for a lot of our players to come forward and say that they really enjoyed working with her, and it was a pretty straightforward, pretty easy decision for us to want to have her here and have her here full-time and do her thing, which is great.”

Hayden laughs as she reflects on what her life was like just one year ago, when she was very happy in her role as an athletic performance coach at Lindenwood University, near her hometown of St. Louis. Even without considering her budding Major League career, she’s the first to admit that her professional career has been anything but traditional.

Her interest in the field stemmed in part from her own experiences of looking for any competitive advantage when she played basketball, softball and soccer when she was young. (“I’m five-two-and-a-half with shoes on,” she says with a laugh.) Academics didn’t come easily to her, so she started her career as an 18-year-old as a physical trainer and managed some gyms around the St. Louis area until she “got burnt out of training soccer moms.”

That gave her important, hands-on experience with developing people skills and sharing her knowledge with a wide variety of people. When she found that she needed the scientific background to bring out her full potential in the field, she went to college at age 24 and emerged with degrees in exercise science and human performance. Her career has since seen stops at EXOS, the University of Louisville, USA Hockey and Team China Women’s Hockey.

“I think it’s just a love of what the weight room means and the power that it can have in the culture that is kind of driven out of that, where we work hard and we see the benefits of it on the field,” Hayden said. “And not to say that that’s everything, but it is something really powerful.”

One day last February, a former colleague, Aaron Rhodes, told her on the phone that a friend had an opportunity in baseball. He asked her to call and just to listen to what the friend had to offer. That friend was Kadish, and he and Hayden immediately had a strong connection as the pair discussed an opportunity with the Major League team.

Except, well, Hayden thought she was missing something.

“I remember being like, a third of the way into our conversation, he hadn’t brought up one time that I was a girl,” Hayden remembers. “And I’m like, ‘Does he not know?'”

“So, do you have any more questions?” Kadish asked at the end of the call.

“Yeah, like, I’m female,” Hayden recalls. “Where do you see that as being an issue or a problem?”

She remembers Kadish laughing.

“Look. Your job is the same as my job,” Kadish told her. “The only way it’s going to be difficult is if you do it differently than I do it. I’m not viewing it at all any differently than what I have to do.”

“He never once flinched at it,” Hayden said. “It never was an option. Like, it never was a disadvantage because of being a female. He only saw it as an advantage.”

Five days later, Hayden was in her car, driving down to Spring Training in Fort Myers. She left a full-time job with benefits and her hometown behind when she left Lindenwood for the fellowship with Kadish and the Twins.

“A personal motto is ‘courage over comfort,’ and choosing the things that maybe are unknown and scary and taking that leap,” Hayden said. “It’s always paid off. And I’m really fortunate that it has.”

It’s a reflection of Hayden’s personality and the seriousness with which she takes her role on a winning team that she’s never really looked to carry herself as any sort of figurehead — and there’s nothing about her day-to-day life that really makes her feel the need to do so. She calls the players her “brothers” and gives and takes friendly jabs with the best of them as she works the weight room.

She jokes that the only difference is that all of her team shirts are in men’s sizes.

“She wants to be low-key,” Kadish said. “She wants to lay low and do her job to the best of her ability and let her work speak for itself. I commend her for that in every aspect. I have no problem blowing her tires up and bumping her up, because she deserves it.”

“I think my success in my career, it’s secondary to [the players] and our success as a team, and I feel that I’m part of them,” Hayden said. “So I’d never want to make myself feel as if I have an individual platform. I have a platform with the Twins. And I really take that seriously. So every win, every loss, I wear that.”

Whether fairly or not, she knows the expectations for her — at least, looking from the outside in — might be higher than they would be for others in her position. She is aware that her success and how she carries herself in this position could open or close the door for other women to follow.

With that in mind, Hayden also said she feels that Kadish, Baldelli, the Twins’ organization and her network also deserve the acknowledgment for putting her in this position and giving her the well-deserved opportunity.

“I attribute a lot of it to a really powerful network of people,” Hayden said. “I’m so humbled that they put their name on me. I say I wear a jersey with a lot of people’s names on my back that have taken a risk on me, whether that was when I was 18 or currently in the big leagues. People have taken a risk to allow me to do what I love, and so I take that really seriously.”

Still, she’s careful to acknowledge the fact that other women around the industry may not have the strong base of support and understanding to facilitate such an easy transition into the industry. Hayden understands that there could be uphill battles and double standards for others in her position.

But that’s not the path she’s forged in the Twins’ organization. And for that, she remains encouraged — and grateful.

“It’s a direction that is obviously needed in the game, and one that nobody sits and stops, and really, it’s what times have evolved into, for the better,” said veteran starter Rich Hill.

“My story has just been awesome,” Hayden said. “And it’s so good and so supportive and being with all these dudes is awesome, and I wouldn’t trade it for anything. So that’s honestly the best part.”

Do-Hyoung Park covers the Twins for MLB.com. Follow him on Twitter at @dohyoungpark and on Instagram at dohyoung.park.

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Hundreds of readers donate copies of depression memoir after Caroline Flack’s death | Books | The Guardian

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An independent bookseller has been deluged with thousands of requests after offering to send anyone who feels they need one a copy of Matt Haig’s memoir about depression, Reasons to Stay Alive, in an initiative the author called “such a positive thing on what was a pretty bleak weekend”.

Simon Key, who runs online retailer the Big Green Bookshop, was contacted by a reader, Emma, offering to buy a couple of copies of Haig’s book for people in the wake of TV presenter Caroline Flack’s death. Haig’s book details his own descent into depression, and his climb back out of it.

Key, who already runs a weekly “buy a stranger a book” club, told his Twitter followers about her offer, and said he’d “try to cover any others that are requested”. As thousands of requests poured in, readers were also quick to support him with donations.

“People have been very generous – some have given a pound or two; others more than £100,” Key said. Donations now stand at around £6,000 and are still coming in, with Key having sent out more than 600 books. He is still making his way through the requests he’s received – “I’m posting about one a minute,” he wrote on Twitter on Sunday – shortly before he leaves for a half-term holiday.

“I’m getting thousands of DMs from people who need the book, and who are telling me why,” Key said on Monday. “This book has made a difference – lots of people have said it saved their lives. And this is not just about people getting the book, it’s about how they’re getting it. They’ve been brave enough to ask for it, and that’s a step forward.”

Blackwell’s in Oxford has also been giving away copies of the book to those who have asked for it, also funded by readers. Deputy manager Charlie Bush said the shop now had 40 books donated by readers, with the retailer discounting the price for donors and covering the postage costs.

“We really believe that books have the power to be life-changing and we also know that lots of people are going through tough times for all sorts of reasons. So we hope that people can gain some comfort and inspiration from Matt’s book. We tip our hats to Big Green Books for getting the ball rolling and offer huge thanks to customers who are making this possible with donations,” said Bush.

Flack had described Haig’s book as “honest and beautiful” on Twitter in 2015 and in the aftermath of her death, the author said that “when I had a bout of Twitter-fuelled depression just as Reasons to Stay Alive came out, this was the tweet that first lifted my spirits. We need more kindness.”

On Monday, Haig told the Guardian that the giveaways were “amazing … such a positive thing on what was a pretty bleak weekend. The response was phenomenal, and the generosity of so many people who volunteered to give copies to other people – online strangers – was, well, there are no words. It was just very touching and shows that the internet, and life in general, are a lot better when we try to look after each other. I am also pleased that this book, which I wrote over five years ago, is still able to help people in some small way.”

In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.

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